Search Results (7)

Background: Trapeziometacarpal osteoarthritis (TMC OA) is a prevalent degenerative disorder that causes considerable pain and functional limitations, especially in older individuals, whose ideal treatment is still debated in the literature. Various treatments are described to restore a good functional outcome of the thumb; over the past 50 years, biological arthroplasties have been considered the gold standard for treating advanced stages of TMC OA. However, in the last decade, the use of dual mobility cup prostheses has significantly increased, with numerous studies reporting excellent clinical outcomes. In this case report, we show the results of a patient treated on the left hand with suspension arthroplasty and on his right hand with dual mobility arthroplasty in one-stage surgery. The aim of this case report is to directly compare outcomes between trapeziometacarpal prosthesis and suspension arthroplasty performed simultaneously in the same patient. Case Presentation: The present case reports a 71-year-old male patient with bilateral TMC osteoarthritis, referred to our clinic in May 2024. His medical history included hypertension, hypertriglyceridemia, paroxysmal atrial fibrillation, and benign prostatic hyperplasia. On examination, the right hand showed grade 3 osteoarthritis according to the Eaton–Littler classification, with the trapezium maintaining adequate bone stock, making the patient eligible for trapeziometacarpal prosthesis implantation. Conversely, the left hand demonstrated scaphotrapezoid arthritis with a slight reduction in trapezial bone stock, indicating the need for trapeziectomy followed by suspension arthroplasty. Both procedures were performed during the same surgical session by the same experienced hand surgeon using a lateral approach. On the right side, the trapeziometacarpal joint surfaces were resected and replaced with a dual mobility prosthesis, while on the left side, the trapezium was excised, and suspension arthroplasty was performed using a slip of the flexor carpi radialis (FCR) tendon. Methods: The patient underwent simultaneous treatment with a dual mobility trapeziometacarpal prosthesis on the right hand and trapeziectomy with suspension arthroplasty on the left hand. Clinical outcomes (grip and pinch strength, pain, QuickDASH, satisfaction, and range of motion) were evaluated at 1, 3, 6, and 12 months. Paired comparative statistics were applied with significance set at p < 0.05. Results: At all follow-up intervals (1, 3, 6, and 12 months), the hand treated with a trapeziometacarpal prosthesis demonstrated superior grip and pinch strength compared to the hand treated with trapeziectomy and suspension arthroplasty, with the greatest difference observed at 3 months. At 12 months, grip strength increased from 28 kg to 40 kg in the prosthesis-treated hand and from 25 kg to 33 kg in the suspension arthroplasty hand. Paired comparisons were performed at each follow-up interval up to 12 months, confirming a significant difference for grip strength. Pain levels (VAS, Visual Analogue Scale) decreased progressively in both hands, with a more rapid reduction in the hand treated with a trapeziometacarpal prosthesis, reaching statistical significance. QuickDASH scores indicated an earlier return to daily activities in the hand treated with the prosthesis, although this difference was not statistically significant. Patient satisfaction was consistently higher for the hand treated with a trapeziometacarpal prosthesis, with the patient reporting a ‘very satisfied’ rating at all timepoints. Range of motion recovery, assessed through the Kapandji score and measurements of thumb abduction and extension, also favored the hand treated with the prosthesis, with statistically significant differences for abduction and extension, whereas the hand treated with trapeziectomy and suspension arthroplasty demonstrated more gradual improvement over time. Conclusions: This case highlights the functional efficacy of both surgical approaches—biological arthroplasty and trapeziometacarpal prosthesis—in the treatment of TMC osteoarthritis. Both procedures resulted in a good clinical outcome and high patient satisfaction. However, recovery was noticeably faster in the hand treated with a trapeziometacarpal prosthesis, which is consistent with findings previously reported in the literature. These observations suggest that, while both techniques are valid and effective, trapeziometacarpal prosthetic replacement may offer a quicker return to function in appropriately selected patients. Full article

Background: Femoral neck fractures (FNFs) in the ageing population carry high risks of postoperative dislocation, with traditional total hip arthroplasty (THA) reporting rates up to 10%. Dual mobility THA (DM-THA) may provide enhanced stability, but evidence for third-generation implants like the Zimmer Biomet G7^® system remains limited. Methods: This retrospective cohort study evaluated 120 patients (mean age 71.6 years; 74% female) with acute displaced intracapsular FNF treated with DM-THA (2021–2023) using the G7^® system. Demographics, surgical details (cemented/uncemented stems), complications, and functional outcomes (Oxford Hip Score (OHS) at one year) were analysed against national benchmarks. Results: Zero dislocations and two peri-prosthetic fracture (0.8%, cemented stem) occurred. Thirty-day mortality was 0.8% (below national averages). Functional recovery was excellent (mean OHS: 41/48; 69% scoring ≥40). Surgical complications were minimal (one deep infection 0.8%). Medical complications (anaemia 6.6%, venous thromboembolism 4.2%) were significantly higher in high ASA groups (III-IV). Radiographs confirmed stable implants without loosening. Conclusions: The G7^® DM-THA system demonstrates exceptional stability and safety in FNF patients, with no dislocation risk and low peri-prosthetic fracture rates—even with cemented stems. These outcomes support its use in high-risk populations, though comparative studies with conventional THA are needed. Full article

Background: Total hip arthroplasty (THA) is a common procedure, yet instability and dislocation remain leading causes of revision. Dual mobility (DM) acetabular constructs improve stability, but comparative data across modular DM systems are limited. This study compared the safety and efficacy of three modular DM implants in primary THA, focusing on acetabular revision and functional recovery. Methods: We retrospectively reviewed 963 primary THAs performed from 2016–2024 using three modular DM systems. Patients with revision or bilateral THA, age < 18, or <2 years of follow-up were excluded. Outcomes included acetabular revision, 90-day readmission, and Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS, JR). Kaplan–Meier analysis estimated 3-year implant survivorship for each implant, and non-inferiority of Implant A was tested against a combined “Dual Mobility Control” cohort (Implants B + C) using a prespecified −10% margin. Results: A total of 297 patients met inclusion criteria (142 Implant A, 110 Implant B, 45 Implant C). Revision rates were 4.9% for Implant A, 6.4% for Implant B, and 8.9% for Implant C. HOOS, JR scores improved significantly in all cohorts with comparable 2-year outcomes. Kaplan–Meier analysis showed 3-year survivorship of 98.3% for Implant A, 98.4% for Implant B, and 96.9% for Implant C (log-rank p = 0.053). The Dual Mobility Control cohort survivorship was 98.0%, and the difference between Implant A and controls (95% CI: −2.19% to 2.69%) met the non-inferiority margin (log-rank p = 0.796). Conclusions: Implant A demonstrated non-inferior 3-year survivorship and comparable short-term patient-reported outcomes relative to two other modular DM implants. Larger, multicenter studies with longer follow-up are warranted to confirm these findings. Full article

Trapeziometacarpal joint osteoarthritis (TMJ OA) is a progressive condition, particularly affecting postmenopausal women. Various surgical techniques have been proposed, but the optimal approach remains debated. This clinical study compares the clinical, functional, and radiological outcomes of two surgical treatments: suspension tenoplasty using the flexor carpi radialis tendon (Altissimi technique, AST) and a dual-mobility prosthesis. The main complications associated with these procedures include postoperative pain, De Quervain’s syndrome, radial nerve injuries, and prosthetic component mobilization. In prosthetic arthroplasty, the most common complication is component mobilization (8%), while in tenoplasty, postoperative pain is the most frequent (15%). A total of 36 patients were randomized into two groups: 18 patients underwent AST (Group A), and 18 received trapeziometacarpal joint arthroplasty (Group B). Functional outcomes were assessed using the Disabilities of the Arm, Shoulder and Hand (DASH), Visual Analogue Score (VAS), and Michigan Hand Outcomes Questionnaire (MHQ) at 3, 6, 12, and 24 months. Range of motion (ROM), Kapandji score, pulp pinch strength, hand grip strength (Jamar dynamometer), and radiological maintenance of the trapezial space (step-off measurement) were also evaluated. Both procedures resulted in significant pain reduction (VAS, p < 0.05) and functional improvement (DASH, MHQ, p < 0.05). ROM increased significantly in both groups. The Kapandji scores improved from 4.0 ± 1.1 to 9.2 ± 1.2 (Group A) and 4.3 ± 0.8 to 7.8 ± 1.4 (Group B) (p < 0.05). Group B grip strength results showed a greater increase in hand grip strength than Group A (p = 0.23). The radiographic step-off showed slight proximal migration of the first metacarpal in Group A, whereas Group B maintained joint height. No implant loosening or major complications were reported in either group. Both suspension tenoplasty and dual-mobility arthroplasty are effective in TMJ OA. AST ensures joint stability with minimal radiographic changes, whereas TJA provides superior grip strength and ROM recovery. The absence of major complications suggests that TJA is a safe alternative to AST, but its higher cost and potential for implant-related complications must be considered. Full article

This study introduces a novel single-degree-of-freedom polycentric knee mechanism specifically designed for transfemoral prostheses to address dual challenges of stability during the stance phase and biomimetic motion during the swing phase. Leveraging analytical kinematic synthesis, the proposed mechanism integrates separate kinematic designs for each of the gait phases into a combined structure that prevents singularity issues during full knee flexion, which is a significant limitation in conventional active designs. The stance phase mechanism emphasizes stability through precise control of the instantaneous center of rotation (ICR) and weight-bearing support, while the swing phase mechanism adopts a biomimetic motion trajectory. In order to validate the proposed methodology, kinematic synthesis, numerical simulations, and visual analyses were conducted. Incorporating insights from polycentric prostheses and orthotic applications, the proposed mechanism achieves a seamless transition between two different configurations by keeping its overall mobility. Additionally, its possible compatibility with motorized actuation offers a foundation for active prosthesis systems, paving the way for adapting the advantages of polycentric prosthesis to active devices. This innovative approach offers a scientifically grounded pathway for improving transfemoral prosthetic systems, advancing both their biomechanical utility and user comfort. Full article

(1) Background: Management of metastatic periacetabular lesions remains a challenging area of orthopaedics. This study aims to evaluate and summarize the currently available reconstructive modalities, including their indications and outcomes. (2) Methods: A scoping review was carried out in accordance with PRISMA guidelines. Medline, EMBASE, and Cochrane were searched for relevant articles. (3) Results: A total of 18 papers met inclusion criteria encompassing 875 patients. The most common primary malignancy was breast (n = 230, 26.3%). Reconstruction modalities used were total hip arthroplasty (n = 432, 49.1%), the Harrington procedure (n = 374, 42.5%), modular hemipelvic endoprotheses (n = 63, 7.2%) and a reverse ice-cream cone prosthesis (n = 11, 1.25%). (4) Conclusions: Advances in implant design including use of dual mobility or flanged cups, tantalum implants, and modular hemipelvic endoprostheses allow for larger acetabular defects to be addressed with improved patient outcomes. This armamentarium of reconstruction options allows for tailoring of the procedure performed depending on patient factors and extent of periacetabular disease. Full article

The dual mobility concept currently represents the newest generation of thumb carpometacarpal prostheses. The aim of this study was to evaluate the short-term outcomes of TOUCH^® prosthesis. From September 2019 to July 2020, 40 prosthesis were implanted in 37 patients suffering from symptomatic stage III osteoarthritis. All included patients with a median age of 57.7 (IQR: 13.6) finished the systematic follow-up regimen (4, 8, 16 weeks, 6, and 12 months postoperatively). All parameters significantly improved (p < 0.0001) compared to the preoperative status. At 1 year follow-up, median DASH Scores decreased from 54 (IQR 22) to 12 (IQR 28) and pain levels improved from 8 (IQR 2) to 1 (IQR 2). Moreover, key-pinch strength increased from 3.8 (2.0) to 5.8 (2.5), while palmar abduction, radial abduction, and opposition also significantly improved. 35/37 patients were satisfied with the functional outcomes. We observed 10 complications, of which 6 were tendon-related issues, and 2 were due to an inappropriate choice of neck size. We could detect one dislocation but no evidence of cup loosening, tilting or subsidence in any patient. Despite the occurrence of some complications, we recommend implantation of this prosthesis type due to favorable clinical and radiological performance. Full article