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Learn the Joint replacement(Hand): Touch implant for Trapezio-metacarpal arthritis (KeriMedical) surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Joint replacement(Hand): Touch implant for Trapezio-metacarpal arthritis (KeriMedical) surgical procedure.

The trapeziectomy has remained a gold standard surgical treatment for thumb base arthritis (in the UK at least), with debate predominantly surrounding the benefits or otherwise of ligament reconstruction of the palmar oblique ligament at the time of trapeziectomy to minimise shortening of the thumb and the extent of pinch grip strength loss.  There have however been joint replacements developed since the 1970’s, initially using silastic and then combinations of metallic components with a polyethylene bearing surface, and more recently interposition arthroplasties and hemi-arthroplasties.

Apart from the potential for dislocation, concerns about joint replacement of the trapeziometacarpal joint predominantly surrounded the risk of trapezial fracture at the time of insertion (although defaulting to trapeziectomy is a good “bail out” option) and loosening of the trapezial component.  Given the fallback is to what would otherwise be considered the gold standard surgical care, joint replacement has been considered as a viable alternative to trapeziectomy in appropriate patients, particularly in Europe and increasingly in the US and the UK.

Replacement will better preserve thumb-ray length, and this, coupled with the better stability of the base of the thumb afforded by a replacement, gives better pinch and grip strengths. Recovery is also faster than following trapeziectomy, due to the need to protect the implant only for as long as capsular healing requires (3-4 weeks), with restoration of pinch and grip functions more quickly than after a trapeziectomy (when 2-3 months of offloading is required to allow for stabilisation of the base of the thumb).

Most replacements will be some form of ball-and-socket articulation, to restore the polyaxial mobility at the TMC joint, accepting a low risk of instability.

The TOUCH prosthesis comprises uncemented components (coated with hydroxyapatite to encourage osseointegration), with a monoblock head/neck articular element with dual mobility trapezial component(mobility between the outer surface of the head and the concavity of the trapezial component. Further mobility between the inner surface of the bearing component and the ball on the end of the neck component affords a wide arc of motion and should also reduce wear debris generation.

Use of a dual-mobility articulation not only provides a better theoretical range of thumb motion, but also a lower rate of dislocation when compared to alternatives (see Results section).

This operative technique demonstrates the surgical steps I use when  inserting a TOUCH prosthesis for trapezio-metacarpal arthritis.

 

OrthOracle readers will also find the following associated instructional operative techniques of interest:

Trapeziectomy and Abductor pollicis longus suspensionplasty

Trapeziectomy with capsuloperiosteal flap interposition arthroplasty

Trapeziectomy with APL suspensionplasty

Trapeziectomy

Trapezium excision arthroplasty and flexor carpi radialis tendon interposition

Proximal Row Carpectomy (for advanced arthritic wrist pain)

Wrist fusion: Radiolunate limited fusion with Acutrak headless screw

 

I am indebted to my colleague Mr Nick Riley FRCS (Tr & Orth), with whom I performed this surgery.

Author: Chris Little FRCS (Tr and Orth)

Institution: The Nuffield Orthopaedic Centre, Oxford, UK.

Clinicians should seek clarification on whether any implant demonstrated is licensed for use in their own country.

In the USA contact: fda.gov
In the UK contact: gov.uk
In the EU contact: ema.europa.eu