Comparison between scaphotrapeziotrapezoid arthrodesis and Pyrocardan® implant for isolated scaphotrapeziotrapezoid osteoarthritis - 27/03/24

Doi : 10.1016/j.otsr.2024.103867

Martin Cholley-Roulleau ^a,⁎ , Gilles Dautel ^a, François Dap ^a, Gabriela Hossu ^a,^b,^c, Philippe Bellemère ^d, Lionel Athlani ^a,^b,^c
^a Department of Hand Surgery, Plastic and Reconstructive Surgery, Nancy University Hospital, centre chirurgical Emile-Gallé, 49, rue Hermite, 54000 Nancy, France
^b Université de Lorraine, Inserm, IADI, 54000 Nancy, France
^c CIC, Innovation technologique (facultatif), CHRU-Nancy, Inserm, université de Lorraine, 54000 Nancy, France
^d Institut de la main Nantes Atlantique, 44800 Saint-Herblain, France

^⁎Corresponding author.

En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Wednesday 27 March 2024

Abstract

Introduction

Scaphotrapeziotrapezoid (STT) arthrodesis and Pyrocardan® implant for painful isolated STT osteoarthritis have shown good results, but no paper has compared their medium-term outcomes.

Hypotheses

Our main hypothesis would be that the Pyrocardan® implant, by preserving the carpal biomechanics, could lead to better wrist mobility. Our secondary hypotheses would be that no other clinical and radiological differences will be found between these two procedures at a mean 5 years follow-up.

Patients

In this non-randomised retrospective study, performed at two healthcare facilities, we report and compare the outcomes of STT arthrodesis with staple fixation versus the Pyrocardan® implant in 38 patients (40 thumbs) from 2 previously published cohorts. Twenty-one patients with a mean age of 68 years (range, 46–79) underwent STT arthrodesis in facility 1. Seventeen patients with a mean age of 61 years (range, 41–80) received a Pyrocardan® implant in facility 2. Patients were reviewed at both facilities by the same examiner who performed a clinical and radiographical assessment.

Results

At a mean follow-up of 8 years (range, 2–20 years) for the STT group and 5 years (range 3–8 years) for the Pyrocardan® group, we found no significant differences in the clinical and radiological outcomes between the two procedures except in wrist active extension and ulnar deviation, where Pyrocardan® appears to produce better mobility (extension 58°± 9 vs. 38°± 14 and ulnar deviation 35°[25, 40] versus 45°[40, 50]) (p<.001 and p<.008 respectively). The two surgical techniques led to significantly improvement in terms of pain relief, function, and strength. For the STT arthrodesis group, two complete non-unions were found (9%), while narrowing of the styloscaphoid joint space was found in eight thumbs (36%). For the Pyrocardan® group, four postoperative DISI (22%), four calcifications around the trapezium and/or distal scaphoid (22%) and one asymptomatic dislocation (6%) of the implant were observed.

Discussion

Pyrocardan® implant seems to result in better mobility in extension and ulnar deviation. STT arthrodesis and Pyrocardan® implant to treat isolated STT osteoarthritis led to less pain, better strength and functional scores, and restored wrist stability. A future study with a larger population will be needed to confirm these results.