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PubMed1981

[Implants].

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Animals↗
PubMed1977

New concepts in arthroplasty of the hand and wrist.

Clinical trials with cemented polyethyiene and metal total joint arthroplasties were initiated in 1973. Replacements have been developed for the wrist, carpometacarpal joint of the thumb, metacarpophalangeal joints of the thumb and fingers, and the proximal interphalangeal joints of the fingers. Results, evaluated by pain relief and joint stability, were excellent at all sites. Motion, however, averaged only 50% of normal. Significant problems included abnormal posture in the wrist, roentgenographic evidence of loosening in the finger metacarpophalangeals, extensor lag in the metacarpophalangeal of the thumb, and lack of motion in the proximal interphalangeal joint of the finger.

Arthritis, Rheumatoid↗
PubMed2006

[Implants in the hand].

Increasingly, implants in the region of hand joints and the wrist represent an alternative for the treatment of post-traumatic, inflamed, or degenerative joint damage. The diversity of hand functions also results in varied solutions, which are effective in their stability, mobility, and distraction. Different materials are necessary for this, and they require subtile radiological control. The native X-ray represents the substantial method to observe migration of the implants. Each interface between titanium, ceramic, zirconium, pyrocarbon, and silicon to the bone has to be assessed differently in order to obtain a relevant statement. The finger joints and to a limited extent the wrist represent the artificial joints with limited alternative therapy. Other implants in the hand should only be applied after strict indication and patient compliance, as arthrodesis and resection arthroplasty have shown very good long-term results.

Arthritis↗
PubMed1996

Isolation and quantitation of debris particles around failed silicone orthopedic implants.

Silicone elastomer implants have a relatively low rate of complications, but inflammatory reactions to debris have been reported. To characterize the size and number of debris particles, we isolated and quantified the debris particles present in the periarticular tissues of 10 patients with failed silicone wrist, elbow, or finger implants. Five rheumatoid synovia without implants were used for negative controls. The number of particles ranged from 0.99 to 24.8 x 10(9) per gram (dry weight) of tissue, and nearly all particles were silicone, as determined by x-ray spectroscopy. The implantation duration ranged from 3.2 to 10.6 years, and for the five wrist implants, the number of particles correlated with duration in vivo. The particles were small (mode particle diameter was 0.59 +/- 0.057 micron). These results suggest that billions of particles, most of which are smaller than 1 micron, are present adjacent to failed silicone implants, and may be associated with inflammation and bone resorption.

Elbow Joint↗
PubMed1978

[Biomechanical aspects of arthrosis of the carpometacarpal joint of the thumb and its treatment with a special endoprosthesis].

The joint between the trapezium and the first metacarpal is anatomically like a saddle. In function, however, it is used like a ball and socket joint with the following possible movements: 1. Flexion - extension, 2. abduction - adduction, 3. opposition and circumduction. The movements in the two first planes are completely congruent, whereas in the third an incongruent motion of the joint is created by the rotation of the metacarpal on the trapezium. In this situation there is joint contact at one point only, being - biomechanically - a prearthrotic deformity as described by HACKENBROCH. Accordingly, the carpometacarpal joint of the thumb in normal use is exposed to special stress which can end in degeneration. When in arthrosis of the carpometacarpal joint of the thumb conservative measures fail, we replace the deformed joint by prosthesis having the construction of a ball and socket joint. The prosthesis (designed by FRANCOBAL) has a metallic part with body, neck and a sphereshaped head, and a polyethylene socket, which can be coupled to the head by a snap mechanism. Both parts are inserted with polymethylmetacrylate cement into the prepared bone of the trapezium and the first metacarpal. The advantages of this method are: no pain, stability of grip, and motion similar to that of a ball and socket joint. Because this motion is physiological, loosening of the implants and their insertions are avoided. The first 8 patients treated with this method show satisfying functional results. The longer follow-up time is 6 years.

Aged↗
PubMed2006

Small joint arthroplasty.

There is little published on the radiology of small joint arthroplasty when compared with the commonly performed hip or knee replacement. The types of joint replacement, their clinical efficacy, and the expected radiographic appearances are reviewed for each of these upper and lower extremity joints. Potential complications and their radiographic appearances are presented.

Ankle Joint↗
PubMed2002

Microscopic metallic wear and tissue response in failed titanium hallux metatarsophalangeal implants: two cases.

The membranes present at the implant-bone interface were retrieved from two patients with titanium single stem hallux implants that had failed. Both patients had pain and valgus deformity of the hallux, and radiographs showed a radiolucent shadow around the implant stem, with thinning of the dorsal cortex of the proximal phalanx in one patient. After removal of the implants, arthrodesis of the first metatarsophalangeal (MP) joint was performed. Histologic analysis of the membrane tissue at the implant-bone interface showed a synovial-like appearance. There was a fibrous tissue stroma adjacent to the bone surface, with multiple regions of scalloping covered by mononuclear cells. Fine metallic debris was seen throughout the fibrous tissue. Multinucleated foreign body giant cells were sparsely observed associated with fine particulate metallic wear debris similar to observations from failed total hip arthroplasties. The histologic appearance is evidence that foreign-body granulomatous infiltration associated with metallic wear debris may be a causative factor of peri-implant osteolysis leading to aseptic loosening and failure of titanium single stem hallux implants.

Aged↗
PubMed1993

Silicone granulomatous reactions after first metatarsophalangeal hemiarthroplasty.

We reviewed 55 patients (78 feet) who had undergone silicone hemiarthroplasty of the first metatarsophalangeal joint for hallux valgus (40) or hallux rigidus (38). At a mean period of 4.5 years (1 to 11), 56 feet had radiological evidence suggestive of silicone granulomatous disease. The frequency and severity of the changes increased with time from the operation. Histological material from three revisions confirmed the presence of silicone granulomata. We recommend that the operation of silicone hemiarthroplasty for hallux valgus and hallux rigidus be abandoned.

Female↗
PubMed1990

LaPorta great toe implant. Long-term study of its efficacy. Student Research Group.

The purpose of this study was to evaluate the long-term function of the LaPorta design great toe implant. Eight cases were evaluated preoperatively and on a short-term (mean = 3.6 months) and a long-term basis (mean = 20.5 months) postoperatively. Findings of clinical importance included decreased hallux dorsiflexion and radiographic evidence of hyperostosis formation at the implant hinge. However, all of the patients studied were satisfied with their results.

Aged↗