18 Silicone Implants and Total Joint Prostheses for Osteoarthritis of the Trapeziometacarpal Joint: A Systematic Review



Nadine Hollevoet and Grey Giddins


Abstract


A systematic review about treatment of osteoarthritis of the trapeziometacarpal joint with silicone implants and total joint replacement was performed. Good subjective outcomes were reported with Swanson prostheses, but their use cannot be recommended because of the risk of dislocation, implant failure, and foreign body reaction. With some of the more recent total joint arthroplasties, good medium-term survival rates were reported and better function in comparison with trapeziectomy and tendon arthroplasty, but prospective randomized studies with strong evidence were not available.




18 Silicone Implants and Total Joint Prostheses for Osteoarthritis of the Trapeziometacarpal Joint: A Systematic Review



18.1 Introduction


In 1968 Swanson published the first report of a thumb carpometacarpal (CMC) joint arthroplasty using a silicone implant. 1 In 1973 de la Caffinière reported a technique with a total joint arthroplasty. 2 Since then many different designs have been developed.


A systematic review was performed to assess the results of thumb trapeziometacarpal arthroplasty. It followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline but was not registered in advance as it built upon a previous review. 3



18.2 Materials and Methods


The inclusion criteria for the systematic review were: full reports written in English or French of total joint replacement or silicone implants in patients with primary osteoarthritis of the trapeziometacarpal joint; studies reporting pain, strength, radiological changes, or failure rates as outcomes with a mean follow-up of at least 12 months; and studies with a design classification of levels I to VI, as classified by Jovell and Navarro-Rubio. 4


The exclusion criteria were: studies with a mean follow-up of less than 12 months; reports of patients with trapeziometacarpal joint osteoarthritis that could not be separated out from cases of secondary osteoarthritis (posttraumatic, rheumatoid, gout, chondrocalcinosis, or other inflammatory conditions); studies describing only surgical techniques, case reports, short report letters, revision procedures, cadaver studies, biomechanical studies, implants other than total joint arthroplasty or silicone implants such as tendon, ceramic, pyrocarbon, or interposition arthroplasty with synthetic or biological implants; and reviews and studies in which more than one type of implants were used and results were not reported separately.


The survival rates of implants and the method to determine these were recorded. Only articles with removal or revision of the prosthesis as end point were selected to assess survival. It was noted whether a cumulative survivorship analysis was performed and with which method. Usually the product-limit method 5 or the method of Armitage 6 was used. Implants were considered to have a good result if the failure rate was lower than 1% per year. For failure rate lower than 1% per year, follow-up of at least 10 years should be considered before any final conclusion is made. In cases of higher failure rates, results can be reported with shorter follow-up. 7


Assessment of the level of evidence was done according to the Jovell and Navarro-Rubio methodology 4 (Table 18.1) and assessment of the methodological quality with the Coleman methodology scoring system, part A 8 (Fig. 18.2).


















































Table 18.1 Classification in levels of evidence based on the type of study design (as described by Jovell and Navarro-Rubio)
Level Strength of evidence Type of study design
I Good Meta-analysis of randomized controlled trials
II Large-sample randomized controlled trials (n ≥ 25)
III Good to fair Small-sample randomized controlled trials (n < 25)
IV Nonrandomized controlled prospective trials
V Nonrandomized controlled retrospective trials
VI Fair Cohort studies
VII Case–control studies
VIII Poor Noncontrolled clinical series; descriptive studies
IX Anecdotes or case reports






















































































Table 18.2 Coleman methodology score
Coleman score
Study size >60 10
41–60 7
20–40 4
<20 or not stated 0
Mean duration of follow-up >24 mo 5
12–24 mo 2
<12 mo, not stated or unclear 0
Number of different surgical procedures included in each reported outcome Only one surgical procedure 10
More than one surgical procedure, but >90% undergoing one procedure 7
Not stated, unclear, or <90% undergoing one procedure 0
Type of study Randomized control study 15
Prospective cohort study 10
Retrospective study 0
Diagnostic certainty In all 5
In >80% 3
In < 80% 0
Description of surgical procedure Adequate 5
Fair 3
Inadequate 0
Description of postoperative rehabilitation Well described, >80% complying 10
Well described, 60–80% complying 5
Protocol not reported or <60–80% complying 0

Authors searched PubMed/Medline databases up to 31 January 2019. The following key terms were used for searching strategy: trapeziometacarpal osteoarthritis, trapeziometacarpal arthroplasty, trapeziometacarpal joint, trapeziometacarpal replacement, thumb CMC arthroplasty, thumb CMC joint replacement, and thumb CMC joint prosthesis. The bibliographies of all relevant papers and reviews were hand-searched.



18.3 Results


A flowchart illustrating the selection of trials included in the systematic review is shown in Fig. 18.1.

Fig. 18.1 Flowchart of the selected trials.


18.3.1 Silicone Implants


Reports of 12 different silicone implants were found during the search. The first four were Swanson prostheses: (1) silicone trapezium implant with convex base, 1 (2) silicone trapezium implant with concave base 9 (Fig. 18.2), (3) silicone convex condylar implant, 10 (4) silicone concave condylar implant. 11 The first Swanson implants were constructed of common silicone elastomer; after 1974 high-performance elastomer was used. 11 Reports of other silicone implants found during the search include: (5) Kessler implant, a silicone implant with Dacron reinforcement. It is implanted without resection of the trapezium, 12 (6) a silicone sponge or disc for interposition in the trapeziometacarpal joint, 13 (7) the Ashworth-Blatt implant, a flat implant with a short stem that is inserted in the trapezium, 14 (8) the Niebauer arthroplasty, a Dacron-reinforced silicone trapezium implant, 15 (9) silicone implant with a tunnel in which a tendon strip can be placed to stabilize the implant, 16 (10) the Helal prosthesis, a silicone rubber ball with two stems, 17 (11) proplast silicone rubber trapezium implant without stem, 18 and (12) the tendon tie-in implant with a narrowed waist in which a tendon sling can be placed to stabilize the implant. 19

Fig. 18.2 Swanson prosthesis.

Twenty-two articles met the inclusion criteria with seven different types of implants. Only articles of one type of Swanson prosthesis were included, i.e., the Swanson trapezium silicone prosthesis with a concave base. Articles of the condylar Eaton implant 16 , 20 and the proplast silicone implant 18 were excluded. Results of Swanson prostheses are reported in Table 18.3 and Table 18.4 and of other silicone implants in Table 18.5 and Table 18.6.
























































































































Table 18.3 Study characteristics of the Swanson silicone trapezium implant
Authors Patients/Implants Mean age at surgery (yr) Follow-up (mo) (mean) Evidence Coleman score
Separate Total
Weilby 21 14/14 60 6–15 (–) VI 0,2,10,0,5,0,0 17
Amadio et al 22 21/25 60 – (26) V 4,5,0,0,5,5,10 29
Sollerman et al 23 33/39 58 132–168 (144) VI 4,5,10,0,5,5,10 39
Creighton et al 24 124/151 62 24–128 (51) VI 10,5,0,0,5,5,10 35
Freeman and Honner 25 37/43 60.5 (at follow-up) 6–162 (66) VI 7,5,10,0,5,5,10 42
Lehmann et al 26 27 65 – (67) V 4,5,10,0,5,5,0 30
Lovell et al 27 52/58 18–90 (62) Tendon and silastic V 7,5,10,0,5,3,5 35
Tägil and Kopylov 28 13 62 22–66 (45) III 0,5,10,15,5,5,10 50
van Cappelle et al 29 35/45 61 90–282 (164) VI 7,5,0,0,5,5,10 29
MacDermid et al 30 25/30 64 36–120 (54) VI 4,5,10,0,5,5,10 39
Taylor et al 31 22 66 ≥12 (–) V 4,2,10,0,5,0,0 21
Burke et al 32 58/69 62 9–228 (92) VI 10,5,10,0,5,5,10 45



































































































































Table 18.4 Details of outcome measurements of the Swanson silicone trapezium implant
Authors Pain Mean grip strength (kg) Mean key pinch strength (kg) Mean tip pinch strength (kg) Radiographic findings Failure rate Predominant complication
Weilby 21 5/14 had pain 2 dislocation 1 subluxation 14% Dislocation 2/14
Amadio et al 22 2/25 still pain 17.9/ silastic/trapeziectomy 5/4.6 silastic/ trapeziectomy 3 subluxation 1 malposition 0% Subluxation
Sollerman et al 23 26/39 no pain 6.2/6.2 N/cm2 operated/contralateral hand 2.3/4.1 preop/postop 4.0/4.4 N/cm2 operated/contralateral hand 56% dislocation or subluxation 51% cyst formation 0% Dislocation
Creighton et al 24 85% less pain than preop 12 no difference with preop 3.5 no difference with preop 56% scaphoid cysts (85/151) 74% metacarpal lucencies 1.6% 2/124 Pancarpal cysts 3/124
Freeman and Honner 25 1.7 (on a scale of 1 to 6) 102% of other side 71% of other side 77% of other side 79% stable 23% wear 53% lucencies 8% Synovitis 3/37
Lehmann et al 26 8.0/8.2 (VAS) silastic/tendon 4.8/3.6 silastic/tendon Proximalization first metacarpal less with silastic than with tendon
Lovell et al 27 78/76 on a scale 0–100, 100: no pain silastic/tendon 4 subluxation 1 stem fracture 1 dislocation 14% Subluxation 4/58
Tägil and Kopylov 28 9/14 (VAS 0–100) silastic/tendon 0.56/0.54 kp/cm2 silastic/tendon 0.34/0.35 kp/cm2 silastic/tendon 2 dislocations dynamic subluxation Bone cysts 0% Subluxation 5/13
van Cappelle et al 29 9 (VAS) 10 meant no pain 50% dislocation or subluxation 16% osteolysis 27% Dislocation (40%)
MacDermid et al 30 5.7/10 = average amount of improvement in pain 18.2/22.3 operated/nonoperated 4.7/6.7 operated/nonoperated 3.3/4.5 operated/nonoperated 90% had osteolysis (1 pancarpal) 10% dislocation 20% 6/30 Silicone synovitis (90%)
Taylor et al 31 18 on a scale of 0 to 100 0 no pain 11 7 1 dislocation 9% 2/22 Dislocation 1/22
Burke et al 32 34 on a scale of 0 to 100 0 no pain 1.5% 1/69 Infection 1















































































































Table 18.5 Study characteristics of other silicone implants
Implant Authors Patients/Implants Mean age at surgery (yr) Follow-up (mo) (mean) Evidence Coleman score
Separate Total
Ashworth-Blatt Ashworth et al 14 37 56 1–75 (34) VI 4,5,10,0,5,5,10 39
Karlsson et al 33 19/20 56 36–96 (54) VI 4,5,10,0,5,0,0 24
Oka and Ikeda 34 16/16 60 12–144 (57) VI 0,5,10,0,5,5,5 30
Minami et al 35 10/12 66 120–252 (180) VI 0,5,10,0,5,5,10 35
Helal O’Leary et al 36 23/27 63 12–138 (59) VI 4,5,10,0,5,5,10 39
Kessler Kessler 37 17/18 Range: 44–66 At least 24 mo VI 0,5,10,0,5,5,5 30
Niebauwer Ferlic et al 38 11 54 12–36 (20) VI 0,2,10,0,5,5,10 32
Adams et al 39 18/22 60 6–68 (28.8) VI 4,5,10,0,5,5,10 39
Silicone sponge Dickson 13 12/16 12–60 (38) VI 0,2,10,0,5,5,10 32
Tendon tie-in Avisar et al 19 22/28 66 12–26 (18) VI 4,2,10,0,0,5,10 31

























































































































Table 18.6 Details of outcome measurements of other silicone implants
Implant Authors Pain Mean grip strength (kg) Mean key pinch strength (kg) Mean tip pinch strength (kg) Radiographic findings Failure rate Predominant complication
Ashworth-Blatt Ashworth et al 14 3/37 no pain 3% Implant fracture 1/37
Karlsson et al 33 0.46/0.24 kp/cm2 operated/ nonoperated 191/152 Units operated/ nonoperated 5 subluxation 7 dislocation In all carpal cysts 55% Foreign body reaction
Oka and Ikeda 34 75% pain-free 7 out of 12 improved postop 5 brim rupture of implant 1 implant breakage 6% Partial rupture 5/16
Minami et al 35 17% pain-free 58% severe pain 12/9.5 preop/ postop 3.2 3.2 4 silicone synovitis 5 implant fracture 2 dislocations 17% Implant breakage 5/12
Helal O’Leary et al 36 26% significant postop pain 19 5 4 no osteolysis no dislocation 3.7% Pain
Kessler Kessler 37 61% pain-free 1 dislocation 5.5% Dislocation
Niebauer Ferlic et al 38 6 moderate and 5 marked pain relief 87% of opposite hand 85% of opposite hand 79% of opposite hand No dislocation No bone erosion 0%
Adams et al 39 14% no improvement 16/20 operated/nonoperated 4.3/6 operated/nonoperated 2/22 instability 9% Dislocation
Silicone sponge Dickson 13 94% no pain 6% Insufficient removal of osteophyte 1
Tendon tie-in Avisar et al 19 7.4/1.2 preop/postop p<0.05 11/11 operated/nonoperated 5.5/6 operated/nonoperated 2 dislocations 7% Dislocation 2/28

Of the 12 articles about the Swanson prosthesis, 7 were evidence level VI, 4 level V, and 1 level III. The mean Coleman score was 34 (range: 17–50). The most commonly reported complications were dislocation and silicone synovitis. Reported failure rates ranged between 0 and 27%. The ten articles about other types of silicone implants were all retrospective with evidence level VI and only reported on a small number of patients. The mean Coleman score was 33 (range: 24–39). Reported complications were dislocation, foreign body reaction, and implant breakage. The highest failure rate was found with the Asworth-Blatt implant (55%).



18.3.2 Total Trapeziometacarpal Joint Implants


Results were found for 21 different total joint prostheses: Arpe prosthesis 40 (Fig. 18.3); Braun-Cutter prosthesis 41 , 42 , 43 ; Beznoska 44 ; Bichat prosthesis 45 ; cemented resurfacement arthroplasty 46 , 47 , 48 ; de la Caffinière prosthesis 49 ; Electra prosthesis 50 ; Guepar I prosthesis 51 , 52 , 53 ; Guepar II prosthesis 54 ; Isis 55 ; Ivory 56 (Fig. 18.4); Ledoux prosthesis 57 ; Maia 58 , 59 ; Mayo Clinic prosthesis 60 ; Moje Acamo 61 ; Moovis 62 ; Motec 63 ; Nahigian prosthesis 64 ; Roseland prosthesis 65 (Fig. 18.5); Rubis II 66 ; and Steffee prosthesis. 67

Fig. 18.3 Arpe prosthesis.
Fig. 18.4 Ivory prosthesis.
Fig. 18.5 Roseland prosthesis.

Papers concerning seven of these did not fit the eligibility criteria because either they included patients with conditions other than primary osteoarthritis (Braun, Guepar I, Ledoux, Maia, Mayo Clinic, and Steffee prostheses) or the results were published in Czech (Beznoska).


Forty-nine articles of the following total joint arthroplasties were included: Arpe (8), Braun-Cutter (1), cemented resurfacement (2), de la Caffinière (8), Electra (7), Guepar II (2), Isis (1), Ivory (4), Maia (3), Moje Acamo (3), Moovis (1), Motec (2), Nahigian (1), Roseland (5) (Fig. 18.5), and Rubis II (2). In one article results were reported of Electra and Motec prostheses. 63


Survivorship with removal of the prosthesis as an end point was reported on ten different total joint prostheses in 21 articles (Table 18.7). The most frequent were of the Arpe, de la Caffinière, and Electra prostheses. Results of those prostheses are presented in Table 18.8, Table 18.9, Table 18.10, Table 18.11, Table 18.12, and Table 18.13; results of other prostheses are shown in Table 18.14 and Table 18.15.



















































































































































































Survivorship of total joint implants for the trapeziometacarpal joint Table 18.7 Survivorship of total joint implants for the trapeziometacarpal joint
Implant Authors N % men % lost Survival Cumulative survival analysis
Arpe Apard and Saint-Cast 68 43 6 26 85% at 5 yr 79% at 11 yr Armitage
der Eecken et al 69 49 18 12 97% at 5 yr None
Cootjans et al 70 166 13 4 96% at 6.5 yr Kaplan Meier
Craig et al 110 39 24.5 95% at 2 yr None
Cemented surface replacement Pendse et al 71 62 34 0 91% at 3 yr Kaplan Meier
Ten Brinke et al 72 10 10 0 80% at 5 yr None
de la Caffinière Wachtl et al 73 43 n/a 19 66% at 5 yr Armitage
Van Cappelle et al 74 77 14 0 72% at 16 yr Armitage
Chakrabarti et al 75 93 12 22 89% at 16 yr Armitage
Johnston et al 76 93 12 47 74% at 26 yr Kaplan Meier
Electra Krukhaug et al 63 29 28 n/a 90% at 5 yr Kaplan Meier
Ivory Goubau et al 56 24 5 8 95% at 5 yr None
Cebrian-Gomez et al 77 84 8 0 96% at 5 yr Kaplan Meier
Maia Toffoli and Teissier 78 116 28 31 93% at 5 yr Kaplan Meier
Caekebeke and Duerinckx 79 50 46 0 96% a 5 yr Kaplan Meier
Moje Acamo Hansen and Vainorius 61 9 33 0 66% at 1 yr None
Motec Krukhaug et al 63 53 40 91% at 5 yr Kaplan Meier
Thilleman et al 80 42 19 0 58% at 2 yr Kaplan Meier
Roseland Semere et al 81 64 6 24 91% at 10 yr None
Rubis II Maes et al 82 118 6 14 93% at 5 yr 90% at 12 yr Kaplan Meier
Dehl et al 83 115 7 45 89% at 10 yr Kaplan Meier























































































Arpe prosthesis Table 18.8 Study characteristics of the Arpe prosthesis
Authors Patients/Implants Mean age at surgery (yr) Follow-up (mo) (mean) Evidence Coleman score
Separate Total
Brutus and Kinnen 84 52/63 55 5–40 (14.8) VI 10,2,10,0,3,5,5 35
Jacoulet 85 29/37 67 – (36) VI 4,5,10,0,3,5,10 37
Apard and Saint-Cast 68 25/32 59 60–138 (86) VI 7,5,10,0,0,5,5 32
der Eecken et al 69 41/49 55 36–132 (72) VI 7,5,10,0,3,5,5 35
Martin-Ferrero 86 60/65 58 120–150 (127.2) VI 10,5,10,10,3,5,0 43
Cootjans et al 70 156/166 58 – (80) VI 10,5,10,10,5,5,10 55
Craik et al 87 83/83 69 – (24) V 10,2,10,0,5,5,10 42
Robles-Molina et al 88 31/31 56 – (56) V 4,5,10,0,5,5,10 39































































































Arpe prosthesis Table 18.9 Details of outcome measurements of the Arpe prosthesis
Authors Pain Mean grip strength (kg) Mean key pinch strength (kg) Mean tip pinch strength (kg) Radiographic findings Failure rate Predominant complication
Brutus and Kinnen 84 0.1 on a scale 0–4. 6.6 (98.5% of opposite side) 3/63 cup loosening; 1/63 stem loosening 5% (3/63) Dislocation 6/63
Jacoulet 85 All pain-free 23 4 1/37 cup loosening 8% (3/37) Dislocation 2/37
Apard and Saint-Cast 68 5/32 pain with prolonged use; 3/32 pain in cold 20 5.7 2/32 dislocation, 5/32 loosening 22% (7/32) Loosening
der Eecken et al 69 1 (VAS) postop 1/43 cup loosening; 1/43 cup perforation, 1/43 polyethylene wear 9% (4/43) Dislocation 2/43
Martin-Ferrero 86 7.4/1.1 (VAS) preop/postop p<0.001 4.3/5.6 preop/postop p=0.005 14% minor loosening; 8% failed 5% (3/65) Loosening
Cootjans et al 70 Mean VAS 0 (range: 0–9) 19/25 preop/postop 4/5 preop/postop 1/166 cup loosening 1/166 cup subsidence 4% 6/166 Dislocation 8/166
Craik et al 87 1 fracture, 1 heterotopic ossification 5% (4/83) Dislocation 8/83
Robles-Molina et al 88 VAS 1.3/1.4 Arpe/tendon 11.8/8.4 Ib Arpe/tendon p<0.001 7% (3/31) Dislocation 3/31























































































De la caffinihre prosthesis Table 18.10 Study characteristics of the de la Caffinière prosthesis
Authors Patients/Implants Mean age at surgery Follow-up (mo) (mean) Evidence Coleman score
Separate Total
de la Caffinière 89 13/13 – (144) VI 0,5,10,0,5,0,0, 20
Nicholas and Calderwood 90 17/20 57 8–120 (64.2) VI 4,5,10,0,5,0,0 24
Chakrabarti et al 75 71/93 57 72–192 (132) VI 10,5,10,0, 0,5,0 30
Wachtl et al 73 – /43 45–81 (64) VI 7,5,10,0,3,5,5 35
van Cappelle et al 74 63/77 62 24–192 (102) VI 10,5,10,0,5,0,0 30
De Smet et al 91 40/43 54 15–69 (26) VI 7,5,10,0,5,5,0 32
De Smet et al 92 27 54 6 – 52 (25) V 4,5,10,0,5,0,0 24
Johnston et al 76 26/39 57 192–312 (228) VI 4,5,10,0,0,0,0 19































































































De la caffinihre prosthesis Table 18.11 Details of outcome measurements using de la Caffinière prosthesis
Authors Pain Mean grip strength (kg force) Mean key pinch strength (kg force) Mean tip pinch strength (kg force) Radiographic findings Failure rate Predominant complication
de la Caffinière 89 9/13 without pain 4 early loosening 4 gradual loosening 31% Loosening
Nicholas and Calderwood 90 80% pain-free 1/20 dislocation; 1/20 trapezial collaps; 1/20 radiolucent lines 0% Pain
Chakrabarti et al 75 93% good pain relief (VAS) 22/21 operated/nonoperated 10/93 loosening (7 cups, 3 stems) 12% (11/93) Loosening
Wachtl et al 73 44% no pain 48% pain with effort 4% pain at rest 28/27.6 operated/nonoperated 7.5/8 operated/nonoperated 3.9/3.8 operated/nonoperated 1/43 dislocation; 9/43 loosening 23% (10/43) Loosening
van Cappelle et al 74 75.4% good pain relief (VAS) 13/77 loosening; 15/77 severe loosening with need for revision 21% (16/77) Loosening
De Smet et al 91 70% good pain relief (VAS) 17.6/23.8 preop/postop p<0.05 5.32/5.97 preop/postop p<0.01 19/43 loosening; 4/43 cup fracture; 1/43 cortex perforation 2% (1/43) Loosening
De Smet et al 92 6.1/5.3 prosthesis versus tendon p > 0.05 17/27 loosening
Johnston et al 76 27 (VAS) 15.7/17.8 operated/nonoperated 2.9/3.7 operated/nonoperated 14/39 loosening (11 cups, 3 stems) 26% Loosening















































































Electra prosthesis Table 18.12 Study characteristics the Electra prosthesis
Authors Patients/Implants Mean age at surgery in yr Follow-up (mo) (mean) Evidence Coleman score
Separate Total
Regnard 50 100/100 59 36–78 (54) VI 10,5,10,10,5,5,0 45
Hansen and Snerum 93 16/17 54 22–52 (35) VI 0,5,10,0,5,5,10 35
Ulrich-Vinther et al 94 36/36 58 12 IV 10,2,0,15,5,5,0 37
Hernández-Cortés et al 95 19/19 57 24–36 (29) VI 0,2,10,10,5,5,0 32
Hansen and Stilling 96 11/11 60 24 III 0,2,10,15,5,5,10 47
Krukhaug et al 63 – /29 62 – (24) VI 4,2,10,0,5,0,0 21
Chug et al 97 14/16 70 12–38 (26) VI 0,5,10,0,5,3,10 23

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May 4, 2022 | Posted by in ORTHOPEDIC | Comments Off on 18 Silicone Implants and Total Joint Prostheses for Osteoarthritis of the Trapeziometacarpal Joint: A Systematic Review
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