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Master Thesis

Reprise de prothèse totale trapézométacarpienne par implant en pyrocarbone C.M.I : étude rétrospective de 30 patients avec un suivi moyen de 7,5 ans

Abstract : There is no consensus on trapezometacarpal arthroplasty revision procedures. Preserving the trapezius and setting up a pyrocarbon hemi-arthroplasty type C.M.I® could help prevent shortening and preserve the kinematics of the thumb. The aim of this study was to evaluate the clinical and radiographic results of 30 cases of trapezometacarpal arthroplasties revisions by C.M.I® pyrocarbon implant in the medium term. We performed a retrospective study of a continuous series of 30 middle-aged 63.5-year-old patients. The average time after initial arthroplasty was 6.1 years. The operated side was the dominant side in 70% of the cases. Surgery included removal of the prosthesis, trapezium reconstruction by bone grafting, and placement of a C.M.I® pyrocarbon implant. The follow-up consisted of a functional evaluation (visual analog pain scale, Quick DASH score, satisfaction), physical evaluation (Kapandji, Grip test, Key pinch, Tip pinch) and radiological analysis (search for complications, measurement of radiolucent border, scapho-metacarpal height, implant centering and remodeling). At the average follow-up of 7.5 years, no surgical recovery was performed. The mean pain score was 1.07 and the mean Quick DASH score was 13%. Twenty-five patients (89%) were satisfied after surgery. The Kapandji index has improved significantly from 7.50 to 9.46 on average. The Grip test was significantly improved from 16.68 kg to 21.50 kg on average. The average post-operative Key pinch was compared to the opposite side by 93%. The average post-operative tip pinch was 88% relative to the opposite side. On the radiographic level, we did not find any dislocation or fracture. We observed a reshaping of the trapezium linked to the footprint of the pyrocarbon with good tolerance in the medium term. In the case of revision of a total trapezo-metacarpal prosthesis, the installation of a C.M.I® pyrocarbon implant associated with a reconstruction of the trapezius seems to be a good alternative to the trapezectomy generally proposed. The reconstruction of the trapezoid, and the in place of this hemiarthroplasty seems to preserve the projection, the length and the stability of the thumb. The functional improvement brought to the patient by this solution makes it an interesting therapeutic option.
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Submitted on : Tuesday, September 22, 2020 - 1:53:28 PM
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Pierre Lavignac. Reprise de prothèse totale trapézométacarpienne par implant en pyrocarbone C.M.I : étude rétrospective de 30 patients avec un suivi moyen de 7,5 ans. Sciences du Vivant [q-bio]. 2020. ⟨dumas-02945533⟩

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