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Joint Surgery

Hand joint surgery: arthritis (CMC, PIP), Dupuytren’s disease (CCH, fasciectomy), and trigger finger management strategies.

Overview

Surgical approaches to the proximal interphalangeal joint are proposed based on pearls and pitfalls to determine the best approach for a given surgery [1]. MatOrtho proximal interphalangeal joint arthroplasty achieves good pain relief, improvement in functional scores, and may improve range of motion with a minimum 2-year follow-up [2]. Caution is advised for proximal interphalangeal joint arthroplasty in patients with stiff joints or those with significant deformity or instability [2]. Revision proximal interphalangeal arthroplasty is associated with a 70% 5-year survival rate [3] and a high incidence of complications [3].

Treatment options for hallux rigidus and osteoarthrosis of the first metatarsophalangeal joint range from non-operative measures to surgical procedures including cheilectomy, arthroplasty, and arthrodesis [4]. Selection of treatment for hallux rigidus and osteoarthrosis of the first metatarsophalangeal joint depends on disease stage and patient factors [4]. Osteoarthritis is likely the most common indication for basal joint arthroscopy [11], while chronic pain and inflammation are useful indications for metacarpophalangeal arthroscopy [11]. Total thumb carpometacarpal joint arthroplasty with a dual mobility prosthesis appears to be a satisfactory solution [6].

Minimally invasive total hip arthroplasty is a safe surgical procedure without increases in operative time, blood loss, operative complication rates, or component malposition rates [18], though the beneficial effect on functional recovery needs proof [18]. The decision for prosthetic arthroplasty versus arthrodesis in the index finger for osteoarthritis or posttraumatic arthritis must be made with patient goals in mind [19]. Prosthetic arthroplasty of the index finger is associated with a greater risk of complications compared to arthrodesis [19]. Results of surgical treatment for finger fractures vary according to fracture type, surgeon experience, and patient compliance [20], as operative techniques and implants for osteosynthesis of finger fractures are continuing to evolve and improve [20].

Anatomy & Pathophysiology

Osseous and Articular Pathology

Fractures of the fingers are better understood with more clearly defined indications for surgical treatment, and operative techniques and implants for osteosynthesis continue to evolve and improve [20]. Results of finger fracture surgery vary according to fracture type, surgeon experience, and patient compliance [20]. The mechanism of vertical locking of the metacarpophalangeal joint in young adults likely involves a volar bony prominence on the metacarpal head blocking extension [27]. For thumb carpometacarpal joint arthritis, total joint arthroplasty with a dual mobility prosthesis is a satisfactory solution [6], while selective thumb carpometacarpal joint denervation is well tolerated with faster recovery compared with trapeziectomy [22]. The majority of hand surgeons in the US use trapeziectomy with ligament reconstruction and tendon interposition as the surgical treatment of choice for thumb carpometacarpal joint arthritis [41]. Health state utility gains occur after basal thumb osteoarthritis surgery irrespective of the surgical technique used [14].

Ligamentous and Soft Tissue Reconstruction

For chronic ulnar collateral ligament injuries of the thumb, the technique using bone suture anchors with free tendon grafts is technically simple, achieves secure fixation, and provides adequate stability for chronically unstable thumb metacarpophalangeal joints [45]. Results of this technique are comparable to traditional methods [45]. Abductor pollicis longus suspension arthroplasty combined with mini TightRope for thumb carpometacarpal joint osteoarthritis shows significant improvement in radial and palmar abduction range of motion [43]. This combined approach also shows significant improvement in VAS pain scores [43], and combined fixation of the first and second metacarpals with a suture button device suppresses subsidence of the first metacarpal [43].

Functional Outcomes and Surgical Indications

Operative management for Dupuytren's contracture is appropriate when metacarpophalangeal or proximal interphalangeal joint contracture exceeds 30 degrees [10]. Thumb metacarpophalangeal joint arthrodesis using an intramedullary fusion device is reproducible, allows for immediate use without immobilization, has a low number of complications, and provides improved function and pain relief [40]. Cleft reconstruction improves hand appearance in patients with central ray deficiency [28], reflecting hand surgery principles that emphasize the balance between restoring function and maintaining aesthetic appearance [31]. Contralateral C7 transfer demonstrates significant improvements in upper limb function with typically mild and transient donor site morbidity [7].

Complications and Procedural Nuances

Trigger Finger Release: Major complications following trigger finger release are unlikely and occur infrequently [16, 25], while minor complications are prominent [16]. The rate of minor complications following open trigger finger release is high and related mostly to wound complications or loss of finger range of motion [25]. Carpal Tunnel Release: Endoscopic carpal tunnel release is a useful and safe alternative when performed by a surgeon familiar with hand anatomy and trained in endoscopic techniques, though it is more complex than standard open procedures [38]. Surgical approaches to the proximal interphalangeal joint are proposed based on pearls and pitfalls for specific surgeries [1].

Implant Analysis

Computer-assisted vector wear analysis demonstrates superior repeatability and accuracy compared with current techniques of manual analysis for determining polyethylene wear [39].

Classification

Surgical Approach Selection: Surgical approaches to the proximal interphalangeal joint are proposed based on pearls and pitfalls to determine the best approach for a given surgery [1].

Arthroplasty Indications and Outcomes: MatOrtho proximal interphalangeal joint arthroplasty achieves good pain relief, improvement in functional scores, and may improve range of motion [2]. Caution is advised for proximal interphalangeal joint arthroplasty in patients with stiff joints or those with significant deformity or instability [2]. Revision proximal interphalangeal arthroplasty is associated with a 70% 5-year survival rate [3] and has a high incidence of complications [3]. Periprosthetic joint infection is uncommon after metacarpophalangeal or proximal interphalangeal arthroplasties [13].

First Metatarsophalangeal Joint Management: Treatment options for hallux rigidus and osteoarthrosis of the first metatarsophalangeal joint range from non-operative measures to surgical procedures including cheilectomy, arthroplasty, and arthrodesis [4]. Selection of treatment for hallux rigidus and osteoarthrosis of the first metatarsophalangeal joint depends on disease stage and patient factors [4].

Thumb Carpometacarpal Joint: Total thumb carpometacarpal joint arthroplasty with a dual mobility prosthesis appears to be a satisfactory solution [6].

Proximal Interphalangeal Joint Surface Replacement: There were significantly more cases with radiologic evidence of loosening in the uncemented group compared to the cemented group for proximal interphalangeal joint surface replacement arthroplasty (p < .001) [24].

Dupuytren's Disease: Operative management for Dupuytren's contracture is appropriate when metacarpophalangeal or proximal interphalangeal joint contracture exceeds 30 degrees [10]. There is wide disparity in scoring systems, definition of recurrence, and recording of complications in surgical treatments for primary Dupuytren's disease [32].

Trigger Finger Release: Major complications following trigger finger release are unlikely [16]. Minor complications are prominent following trigger finger release [16].

Finger Fractures: Indications for surgical treatment of finger fractures are more clearly defined [20]. Operative techniques and implants for osteosynthesis of finger fractures are continuing to evolve and improve [20]. Results of surgical treatment for finger fractures vary according to fracture type, surgeon experience, and patient compliance [20].

Other Considerations: Observed differences in knee scores between study groups not matched for clinically relevant factors likely represent differences in patient populations rather than differences in operative technique or implant design [5]. Evaluation of coxa vara in childhood should include a search for family history, trauma, infection, and associated skeletal abnormalities to classify the condition and select optimal treatment [8].

Clinical Presentation

Surgical approaches for the proximal interphalangeal (PIP) joint are selected based on specific surgical pearls and pitfalls [1]. For hallux rigidus and osteoarthrosis of the first metatarsophalangeal joint, treatment options range from non-operative measures to surgical procedures including Cheilectomy, Arthroplasty, and Arthrodesis [4]. Selection of treatment depends on disease stage and patient factors [4]. Proximal interphalangeal joint arthroplasty achieves good pain relief and improvement in functional scores [2] and may improve range of motion [2]. Caution is advised for PIP arthroplasty in patients with stiff joints or significant deformity/instability [2]. Revision PIP arthroplasty is associated with a 70% 5-year survival rate [3] and has a high incidence of complications [3].

Evaluation of coxa vara in childhood should include a search for family history, trauma, infection, and associated skeletal abnormalities [8]. Observed differences in knee scores between study groups not matched for clinically relevant factors likely represent differences in patient populations rather than differences in operative technique or implant design [5]. Autologous Matrix-Induced Chondrogenesis (AMIC) is an effective and safe method for treating symptomatic full-thickness chondral defects of the knee in appropriately selected cases [9].

Operative management for Dupuytren's contracture is appropriate when metacarpophalangeal or proximal interphalangeal joint contracture exceeds 30 degrees [10]. Osteoarthritis is the most common indication for basal joint arthroscopy [11], while chronic pain and inflammation are useful indications for metacarpophalangeal arthroscopy [11]. Synovectomy alone is advisable only in selected cases of rheumatoid involvement of the hand and wrist with isolated synovial involvement and no underlying joint pathology [12]. In advanced cases of rheumatoid involvement, complete débridement accompanied by arthrodesis or ulnar head resection is the treatment of choice to arrest disease progression [12]. Periprosthetic joint infection (PJI) is uncommon after primary metacarpophalangeal and proximal interphalangeal arthroplasty [13].

Arthroscopy for fracture of the trapezium provides direct visualization and accurate restoration of articular congruity [15] and yields excellent results [15]. Major complications following trigger finger release are unlikely [16], though minor complications are prominent [16]. Knowledge of Hajdu-Cheney syndrome assists hand surgeons in appropriately diagnosing, assessing, and referring patients with hand deformities associated with the syndrome [21]. Selective thumb carpometacarpal joint denervation for painful arthritis is well tolerated [22] and results in faster recovery compared with trapeziectomy [22].

Investigations

Plain radiography: Evaluation of coxa vara in childhood requires a search for family history, trauma, infection, and associated skeletal abnormalities to classify the condition and select optimal treatment [8]. In the context of metacarpophalangeal joint pathology, standing X-rays are utilized to stabilize the evolution of degenerative lesions following double semitendinosus anterior cruciate ligament reconstruction [29]. For proximal interphalangeal joint surface replacement arthroplasty, radiographs reveal significantly more cases with evidence of loosening in the uncemented group compared to the cemented group (p < .001) [24].

MRI: Magnetic resonance imaging indicates that the donor site after autologous osteochondral mosaicplasty for cartilaginous lesions of the elbow joint is resurfaced with fibrous tissue [36].

Other Considerations: Surgical approaches for the proximal interphalangeal joint are proposed based on pearls and pitfalls to determine the best approach for a given surgery [1]. MatOrtho proximal interphalangeal joint arthroplasty achieves good pain relief, improvement in functional scores, and may improve range of motion, though caution is advised for patients with stiff joints or those with significant deformity or instability [2]. Observed differences in knee scores between study groups not matched for clinically relevant factors likely represent differences in patient populations rather than differences in operative technique or implant design [5]. Autologous Matrix-Induced Chondrogenesis (AMIC) is an effective and safe method for treating symptomatic full-thickness chondral defects of the knee in appropriately selected cases [9]. Osteoarthritis is likely the most common indication for basal joint arthroscopy, while chronic pain and inflammation are useful indications for metacarpophalangeal arthroscopy [11]. Synovectomy alone is advisable only in selected cases of rheumatoid involvement of the hand and wrist with isolated synovial involvement and no underlying joint pathology; in advanced cases, complete débridement accompanied by arthrodesis or ulnar head resection is the treatment of choice to arrest disease progression [12]. Periprosthetic joint infection (PJI) is uncommon after metacarpophalangeal or proximal interphalangeal arthroplasties [13]. Health state utility gains occur after basal thumb osteoarthritis surgery irrespective of the surgical technique used [14]. Arthroscopy provides direct visualization and accurate restoration of articular congruity for fracture of the trapezium, yielding excellent results [15]. Knowledge of Hajdu-Cheney syndrome may help hand surgeons appropriately diagnose, assess, and refer patients to rheumatologists or bone metabolism specialists [21]. Technologic advances in implant materials, design, amputee care, and imaging continue to drive improvements in patient care and outcomes [23]. The mechanism of vertical locking of the metacarpophalangeal joint in young adults likely involves a volar bony prominence on the metacarpal head blocking extension [27]. Cleft reconstruction improves hand appearance in patients with central ray deficiency [28]. Techniques of arthrodesis and arthroplasty for the ischemic hand in systemic scleroderma based on recognition and preservation of specific vascular networks result in alleviation of painful contractures, uniform wound healing, and restoration of a functional arc of digital motion [44].

Treatment

Non-Operative

Surgical intervention for basal thumb osteoarthritis is indicated once a trial of non-operative treatment has failed in a compliant patient [35]. For hallux rigidus and osteoarthrosis of the first metatarsophalangeal joint, treatment options range from non-operative measures to surgical procedures [4]. Operative management for Dupuytren's contracture is appropriate when metacarpophalangeal or proximal interphalangeal joint contracture exceeds 30 degrees [10].

Operative

Indications: Osteoarthritis is likely the most common indication for basal joint arthroscopy [11], while chronic pain and inflammation serve as useful indications for metacarpophalangeal joint arthroscopy [11]. Evaluation of coxa vara in childhood should include a search for family history, trauma, infection, and associated skeletal abnormalities to classify the condition and select optimal treatment [8]. Selection of treatment for hallux rigidus and osteoarthrosis of the first metatarsophalangeal joint depends on disease stage and patient factors [4]. The decision for prosthetic arthroplasty versus arthrodesis in the index finger for osteoarthritis or posttraumatic arthritis must be made with patient goals in mind [19].

Surgical Approach / Technique: Surgical approaches to the proximal interphalangeal joint are proposed based on pearls and pitfalls to determine the best approach for a given surgery [1]. Arthroscopy provides direct visualization and accurate restoration of articular congruity for fracture of the trapezium [15]. In advanced cases of rheumatoid involvement of the hand and wrist, complete débridement accompanied by arthrodesis or ulnar head resection is the treatment of choice to arrest disease progression [12]. Synovectomy alone is advisable only in selected cases with isolated synovial involvement and no underlying joint pathology [12].

Implant Selection: Proximal interphalangeal joint arthroplasty achieves good pain relief, improvement in functional scores, and may improve range of motion [2]. Total joint arthroplasty with a dual mobility prosthesis appears to be a satisfactory solution for the thumb carpometacarpal joint [6]. Basal thumb osteoarthritis surgery improves health state utility irrespective of the surgical technique used [14]. Technologic advances in implant materials, design, amputee care, and imaging continue to drive improvements in patient care and outcomes [23].

Alignment / Balancing Strategy: Minimally invasive total hip arthroplasty is a safe surgical procedure without increases in operative time, blood loss, operative complication rates, or component malposition rates [18].

Pain Management: Arthroscopic debridement and synovectomy improve pain scores, functional scores, subjective outcome, and pinch strength more so than traditional nonoperative therapy for basal joint arthritis [30].

Adjuncts: Contralateral C7 transfer demonstrates significant improvements in upper limb function in stroke or brain-injured patients [7]. The contralateral C7 transfer procedure is confirmed to be safe and effective [7], with donor site morbidity typically being mild and transient [7].

Other Considerations: Caution is advised for proximal interphalangeal joint arthroplasty in patients with stiff joints or those with significant deformity or instability [2]. Prosthetic arthroplasty of the index finger is associated with a greater risk of complications compared to arthrodesis [19]. Proximal interphalangeal joint arthroplasty performed on multiple digits results in no worse outcomes compared with single digit proximal interphalangeal joint arthroplasty [17]. Proximal interphalangeal joint arthroplasty performed on multiple digits has similar rates of complications, reoperation, and revision surgery compared with single digit procedures [17]. Arthroscopy for fracture of the trapezium yields excellent results [15]. Autologous Matrix-Induced Chondrogenesis (AMIC) is an effective and safe method for treating symptomatic full-thickness chondral defects of the knee in appropriately selected cases [9]. The beneficial effect of minimally invasive total hip arthroplasty on functional recovery needs proof [18].

Revision

Revision proximal interphalangeal arthroplasty is associated with a 70% 5-year survival rate [3]. Revision proximal interphalangeal arthroplasty is associated with a high incidence of complications [3].

Complications

Infection (PJI): Periprosthetic joint infection is uncommon following metacarpophalangeal or proximal interphalangeal arthroplasties [13].

Stiffness / Arthrofibrosis: Proximal interphalangeal joint arthroplasty carries a risk of complications in joints that are already stiff, or those presenting with significant deformity or instability [2]. Major complications of open trigger finger release occur infrequently; however, the rate of minor complications is surprisingly high and relates mostly to loss of finger range of motion [25].

Wound complications: Corticosteroid and hyaluronic acid injections for thumb carpometacarpal arthritis increase the odds of post-operative complications [33]. Minor complications following open trigger finger release are related mostly to wound complications [25].

Other Considerations: Revision proximal interphalangeal arthroplasty was associated with a 70% 5-year survival but with a high incidence of complications [3]. The decision for prosthetic arthroplasty versus arthrodesis in the index finger must consider the greater risk of complications associated with arthroplasty [19]. Despite major primary complications and a high incidence of radiographic signs of degenerative changes after 8.8 years, mainly good clinical results were achieved with Judet's bipolar prosthesis [37]. Donor site morbidity for contralateral C7 transfer is typically mild and transient [7]. Observed differences in knee scores between different study groups that have not been matched for various clinically relevant factors are at least as likely to represent differences in the patient populations as they are to represent differences in the operative technique or the design of the implant [5].

Recovery

Light activity (weeks): Evidence regarding specific week ranges for light activity or driving is not provided in the current evidence base. However, contralateral C7 transfer is confirmed to be safe and effective for stroke or brain-injured patients, with donor site morbidity typically mild and transient [7]. For Dupuytren disease, dermofasciectomy offers substantial long-term benefits in function and disease control [34]. In the context of thumb basal joint arthroplasty, the intermediate term (5 years minimum) rate of reoperation for any reason was 2% [26].

Full activity (months): Proximal interphalangeal joint arthroplasty may improve range of motion and achieves good pain relief and improved functional scores [2]. For patients undergoing double semitendinosus anterior cruciate ligament reconstruction, the procedure is efficient in restoring satisfactory stability for most patients and stabilizes the evolution of degenerative lesions as shown by standing X-ray [29]. All patients undergoing distraction osteogenesis reconstruction following resection of bone sarcomas achieved full, independent weight-bearing at a median of 12 months [49].

Complete recovery / outcome plateau (months): Revision proximal interphalangeal arthroplasty is associated with a 70% 5-year survival rate [3]. Basal thumb osteoarthritis surgery improves health state utility irrespective of the surgical technique used [14]. Approximately one-fourth of reoperation cases following thumb basal joint arthroplasty require revision arthroplasty for symptomatic subsidence or instability [26].

Rehabilitation protocol: Treatment options for hallux rigidus and osteoarthrosis of the first metatarsophalangeal joint range from non-operative measures to surgical procedures including cheilectomy, arthroplasty, and arthrodesis, with selection depending on disease stage and patient factors [4]. In advanced rheumatoid involvement of the hand and wrist, complete débridement accompanied by arthrodesis or ulnar head resection is the treatment of choice to arrest disease progression [12]. Synovectomy alone is advisable only in selected cases with isolated synovial involvement and no underlying joint pathology [12]. Direct exchange arthroplasty for infection after total hip replacement can yield a rate of success comparable with delayed exchange if antibiotic-loaded cement and appropriate postoperative antibiotics are used [46].

Functional milestones: Proximal interphalangeal joint arthroplasty performed on multiple digits results in no worse outcomes compared with single digit proximal interphalangeal joint arthroplasty regarding complications, reoperation, and revision surgery rates [17]. Total joint arthroplasty with a dual mobility prosthesis appears to be a satisfactory solution for the thumb carpometacarpal joint [6]. Forty-seven (96 per cent) of forty-nine shoulders had a good clinical result after distal release of deltoid muscle contracture [47]. Mobile-bearing and fixed-bearing all-polyethylene tibial component total knee arthroplasty designs functioned equivalently at the time of early follow-up in low-to-moderate-demand patient groups [48].

Other Considerations: Caution is advised for proximal interphalangeal joint arthroplasty in stiff joints or those with significant deformity or instability [2]. Revision proximal interphalangeal arthroplasty has a high incidence of complications [3]. Observed differences in knee scores between study groups not matched for clinically relevant factors likely represent differences in patient populations rather than differences in operative technique or implant design [5]. Autologous Matrix-Induced Chondrogenesis (AMIC) is an effective and safe method for treating symptomatic full-thickness chondral defects of the knee, indicated for appropriately selected cases [9].

Key Evidence

  • [L5] It proposes the best surgical approach for a given surgery on the PIP joint based on pearls and pitfalls. (10.1016/j.jhsa.2015.11.013)
  • [L4] Patients can be advised that the procedure achieves good pain relief, improvement in functional scores and may improve range of motion, though caution is advised for stiff joints or those with significant deformity/instability. (10.1177/1753193415614251)
  • [L3] Revision arthroplasty was associated with a 70% 5-year survival but with a high incidence of complications. (10.1016/j.jhsa.2015.05.015)
  • [L5] Treatment options range from non-operative measures to various surgical procedures including cheilectomy, arthroplasty, and arthrodesis, with selection depending on disease stage and patient factors. (10.2106/00004623-199806000-00015)
  • [L4] Observed differences in knee scores between different study groups that have not been matched for various clinically relevant factors are at least as likely to represent differences in the patient populations as they are to represent differences in the operative technique or the design of the implant. (10.2106/00004623-199706000-00009)
  • [L4] Total joint arthroplasty with a dual mobility prosthesis appears to be a satisfactory solution in our series. (10.1177/1558944718797341)
  • [L5] Published clinical results have demonstrated significant improvements in upper limb function, confirming the procedure's safety and efficacy, with donor site morbidity that is typically mild and transient. (10.1177/17531934251314640)
  • [L5] Evaluation should include a search for family history, trauma, infection, and associated skeletal abnormalities to classify coxa vara and select optimal treatment. (10.5435/00124635-199803000-00003)
  • [L4] AMIC is an effective and safe method of treating symptomatic full-thickness chondral defects of the knee in appropriately selected cases. (10.1007/s00167-010-1042-3)
  • [L5] Operative management is appropriate when metacarpophalangeal or proximal interphalangeal joint contracture exceeds 30 degrees. (10.5435/00124635-199801000-00003)
  • [L5] Osteoarthritis will likely remain the most common indication for basal joint arthroscopy while chronic pain and inflammation are useful indications for metacarpophalangeal arthroscopy. (10.1016/j.jhsa.2007.02.020)
  • [L4] Synovectomy alone is advisable only in selected cases with isolated synovial involvement and no underlying joint pathology; in more advanced cases, complete débridement accompanied by arthrodesis or ulnar head resection is the treatment of choice to arrest disease progression. (10.2106/00004623-196648060-00006)
  • [L4] PJI is uncommon after MCP or PIP arthroplasties. (10.1016/j.jhsa.2024.12.008)
  • [L3] This study demonstrates health state utility gains after basal thumb osteoarthritis surgery regardless of surgical techniques used. (10.1177/1753193420909753)
  • [L4] Arthroscopy provides direct visualization and accurate restoration of articular congruity, yielding excellent results. (10.1016/j.arthro.2006.07.051)
  • [L3] Major complications following trigger finger release are unlikely; however, minor complications are prominent. (10.1177/15589447221081869)
  • [L4] Proximal interphalangeal joint arthroplasty performed on multiple digits results in no worse outcomes compared with single digit proximal interphalangeal joint arthroplasty, with similar rates of complications, reoperation, and revision surgery. (10.1177/1753193418765691)
  • [L1] MIS THA is a safe surgical procedure without increases in operative time, blood loss, operative complication rates and component malposition rates, though its beneficial effect on functional recovery needs proof. (10.1186/1471-2474-11-92)
  • [L3] The decision for prosthetic arthroplasty versus arthrodesis in the index finger of patients with osteoarthritis or posttraumatic arthritis must be made with patient goals in mind and in light of greater risk of complications associated with arthroplasty. (10.1016/j.jhsa.2015.05.021)
  • [L5] Fractures of the fingers are better understood, indications for surgical treatment are more clearly defined, and operative techniques and implants for osteosynthesis are continuing to evolve and improve, though results vary according to fracture type, surgeon experience, and patient compliance. (10.1054/jhsb.2002.0889)
  • [L4] A brief knowledge of the syndrome may help the hand surgeon to appropriately diagnose, assess, and refer these patients to rheumatologists or bone metabolism specialists. (10.1016/j.jhsa.2020.02.012)
  • [L4] The procedure is well tolerated, with faster recovery as compared with trapeziectomy. (10.1016/j.jhsa.2018.04.030)
  • [L3] There were significantly more cases with radiologic evidence of loosening in the uncemented group (p < .001). (10.1016/j.jhsa.2008.01.030)
  • [L4] Major complications occur infrequently, but the rate of minor complications was surprisingly high and related mostly to wound complications or loss of finger range of motion. (10.1016/j.jhsa.2009.12.040)
  • [L4] The intermediate term (5 years minimum) rate of reoperation following thumb BJA for any reason was 2%, with only approximately one-fourth of reoperation cases requiring revision arthroplasty for symptomatic subsidence or instability. (10.1016/j.jhsg.2023.12.013)
  • [L4] The mechanism likely involves a volar bony prominence on the metacarpal head blocking extension. (10.1016/j.jhsa.2011.06.021)
  • [L4] Cleft reconstruction improves hand appearance in patients with central deficiency. (10.1016/j.jhsa.2008.05.010)
  • [L4] The study shows that the procedure is efficient in restoring a satisfactory stability for most patients and stabilises the evolution of the degenerative lesions as shown by standing X-ray. (10.1007/s001670050076)
  • [L3] This study shows that arthroscopic debridement and synovectomy improve pain scores, functional scores, subjective outcome, and pinch strength more so than traditional nonoperative therapy. (10.1016/j.arthro.2009.06.031)
  • [L1] There is wide disparity in scoring systems, definition of recurrence, and recording of complications, making critical comparison of techniques impossible. (10.1177/1753193410376286)
  • [L4] Corticosteroid and hyaluronic acid injections for thumb carpometacarpal arthritis increase the odds of post-operative complications. (10.1177/1753193418805391)
  • [L3] Dermofasciectomy appears to be a highly effective surgical intervention for advanced Dupuytren disease, offering substantial long-term benefits in terms of function and disease control. (10.1016/j.jhsa.2025.02.007)
  • [L5] It emphasizes that surgical intervention is the next step once a trial of non-operative treatment has failed in a compliant patient. (10.1007/s11552-007-9068-9)
  • [L4] However, magnetic resonance imaging indicates that the donor site is resurfaced with fibrous tissue. (10.1177/0363546507306465)
  • [L4] Despite major primary complications and high incidence of radiographic signs of degenerative changes after 8.8 years, mainly good clinical results were achieved with Judet's bipolar prosthesis. (10.1016/j.jse.2010.05.022)
  • [L4] Endoscopic carpal tunnel release is a useful and safe alternative when performed by a surgeon familiar with hand anatomy and trained in endoscopic techniques, though it is more complex than standard open procedures. (10.1007/s001670050097)
  • [L4] Computer-assisted vector wear analysis demonstrated superior repeatability and accuracy compared with current techniques of manual analysis. (10.2106/00004623-199711000-00004)
  • [L3] Metacarpophalangeal joint arthrodesis of the thumb with the intramedullary fusion device is reproducible, allows for immediate use without immobilization, has a low number of complications, and provides improved function and pain relief. (10.1016/j.jhsg.2023.07.019)
  • [L2] The majority of hand surgeons in the US use trapeziectomy with LRTI as the surgical treatment of choice for thumb CMC arthritis. (10.1016/j.jhsa.2016.11.029)
  • [L4] This surgical technique showed significant improvement in the ROM of radial and palmar abduction and the VAS score for pain, and the combined fixation of the first and second metacarpals with suture button device suppressed the subsidence of the first metacarpal. (10.1177/15589447221120849)
  • [L4] Techniques of arthrodesis and arthroplasty based on recognition and preservation of specific vascular networks have consistently demonstrated a favorable outcome, resulting in alleviation of painful contractures, uniform wound healing, and restoration of a functional arc of digital motion. (10.1016/j.jhsa.2018.03.008)
  • [L4] The technique using bone suture anchors with free tendon grafts is technically simple, achieves secure fixation, and provides adequate stability for chronically unstable thumb MP joints with results comparable to traditional methods. (10.1054/jhsb.1999.0353)
  • [L4] The experience suggests that direct exchange can yield a rate of success comparable with that of delayed exchange if antibiotic-loaded cement and appropriate postoperative antibiotics are used. (10.2106/00004623-199807000-00004)
  • [L3] Forty-seven (96 per cent) of the forty-nine shoulders had a good clinical result after distal release of the contracture. (10.2106/00004623-199802000-00010)
  • [L1] The two designs functioned equivalently at the time of early follow-up in this low-to-moderate-demand patient group. (10.2106/jbjs.j.00157)
  • [L2] All patients achieved full, independent weight-bearing at a median of 12 months. (10.2106/jbjs.23.00707)

See Also

References

[1] Surgical Approaches to the Proximal Interphalangeal Joint. The Journal of Hand Surgery. 2016. DOI: 10.1016/j.jhsa.2015.11.013

[2] MatOrtho proximal interphalangeal joint arthroplasty: minimum 2-year follow-up. Journal of Hand Surgery (European Volume). 2016. DOI: 10.1177/1753193415614251

[3] Revision Proximal Interphalangeal Arthroplasty: An Outcome Analysis of 75 Consecutive Cases. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.05.015

[4] Current Concepts Review - Hallux Rigidus and Osteoarthrosis of the First Metatarsophalangeal Joint. The Journal of Bone & Joint Surgery*. 1998. DOI: 10.2106/00004623-199806000-00015

[5] Demographic Biases of Scoring Instruments for the Results of Total Knee Arthroplasty. The Journal of Bone & Joint Surgery*. 1997. DOI: 10.2106/00004623-199706000-00009

[6] Total Thumb Carpometacarpal Joint Arthroplasty: A Retrospective Functional Study of 28 MOOVIS Prostheses. HAND. 2018. DOI: 10.1177/1558944718797341

[7] Harnessing the uninjured hemisphere for treatment of the stroke or brain-injured patient – evolution of the contralateral C7 transfer. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934251314640

[8] Coxa Vara in Childhood: Evaluation and Management. Journal of the American Academy of Orthopaedic Surgeons. 1998. DOI: 10.5435/00124635-199803000-00003

[9] Mid‐term results of Autologous Matrix‐Induced Chondrogenesis for treatment of focal cartilage defects in the knee. Knee Surgery, Sports Traumatology, Arthroscopy. 2010. DOI: 10.1007/s00167-010-1042-3

[10] Dupuytren’s Contracture. Journal of the American Academy of Orthopaedic Surgeons. 1998. DOI: 10.5435/00124635-199801000-00003

[11] Arthroscopy of the Trapeziometacarpal and Metacarpophalangeal Joints. The Journal of Hand Surgery. 2007. DOI: 10.1016/j.jhsa.2007.02.020

[12] Posterior (Dorsal) Synovectomy for Rheumatoid Involvement of the Hand and Wrist. The Journal of Bone & Joint Surgery. 1966. DOI: 10.2106/00004623-196648060-00006

[13] Incidence and Presentation of Periprosthetic Joint Infection After Primary Metacarpophalangeal and Proximal Interphalangeal Arthroplasty. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.12.008

[14] Basal thumb osteoarthritis surgery improves health state utility irrespective of technique: a study of UK Hand Registry data. Journal of Hand Surgery (European Volume). 2020. DOI: 10.1177/1753193420909753

[15] Arthroscopy in the Treatment of Fracture of the Trapezium. Arthroscopy. 2007. DOI: 10.1016/j.arthro.2006.07.051

[16] Complications Following Endoscopic and Open Trigger Finger Release: A Retrospective Comparative Study. HAND. 2022. DOI: 10.1177/15589447221081869

[17] Impact of multi- versus single finger proximal interphalangeal joint arthroplasty: analysis of 249 fingers treated in 15 years. Journal of Hand Surgery (European Volume). 2018. DOI: 10.1177/1753193418765691

[18] Minimally invasive and computer-navigated total hip arthroplasty: a qualitative and systematic review of the literature. BMC Musculoskeletal Disorders. 2010. DOI: 10.1186/1471-2474-11-92

[19] Prosthetic Arthroplasty Versus Arthrodesis for Osteoarthritis and Posttraumatic Arthritis of the Index Finger Proximal Interphalangeal Joint. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.05.021

[20] Treatment of Fractures of the Fingers. What’s New?. Journal of Hand Surgery. 2003. DOI: 10.1054/jhsb.2002.0889

[21] Hand Deformities in Hajdu-Cheney Syndrome: A Case Series of 3 Patients Across 3 Consecutive Generations. The Journal of Hand Surgery. 2021. DOI: 10.1016/j.jhsa.2020.02.012

[22] Selective Thumb Carpometacarpal Joint Denervation for Painful Arthritis: Clinical Outcomes and Cadaveric Study. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2018.04.030

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[26] Reoperation Rate Following Thumb Basal Joint Arthroplasty: A Minimum Follow-Up Period of 5 Years. Journal of Hand Surgery Global Online. 2024. DOI: 10.1016/j.jhsg.2023.12.013

[27] Vertical Locking of the Metacarpophalangeal Joint in Young Adults. The Journal of Hand Surgery. 2011. DOI: 10.1016/j.jhsa.2011.06.021

[28] Central Ray Deficiency: Subjective and Objective Outcome of Cleft Reconstruction. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2008.05.010

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