ٹچ انگوٹھے کی آرتھروپلاسٹی

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview¶

• The Elektra prosthesis for trapeziometacarpal osteoarthritis demonstrated fast pain relief, maintenance of mobility, and a gradual increase in grip strength [1].
• The Elektra prosthesis for trapeziometacarpal osteoarthritis had a revision rate of 44% after 72 months [1].
• Trapeziometacarpal prosthesis enhances function, thumb length, and patient recovery in TMC arthrosis [2].
• Limiting the magnitude of thumb loads after arthroplasty may contribute positively to the longevity of the procedure [3].
• The Touch® trapeziometacarpal joint arthroplasty has a 96% implant survival rate at 2 years [4].
• The Touch® trapeziometacarpal joint arthroplasty is recommended as the standard treatment for patients with isolated trapeziometacarpal joint osteoarthritis [4].
• The MOOVIS prosthesis is recommended for the treatment of advanced trapeziometacarpal osteoarthritis in people having an activity without too many manual constraints due to the absence of prosthesis instability [5].
• The Elektra prosthesis for trapeziometacarpal osteoarthritis showed poor outcomes after 2 years, leading authors to not recommend this implant [6].
• Total joint arthroplasty in primary trapeziometacarpal joint arthritis results in low pain levels, excellent mobility, clinical function, and high patient satisfaction [7].
• The MAÏA trapeziometacarpal prosthesis represents a long-term solution for surgical treatment of thumb rhizarthrosis [8].
• MAÏA TMC total joint arthroplasty provides very good results for pain relief, strength, mobility, and restoration of the thumb length [10].
• MAÏA TMC total joint arthroplasty provides correction of most thumb z-deformities [10].

Anatomy & Pathophysiology¶

Bony Anatomy & Joint Mechanics¶

• The thumb metacarpal is independent and articulates with the trapezium [26].
• The thumb ray is the most divergent of the five rays of the hand [26].
• The thumb has a more proximal and lateral position than the four fingers, allowing movement inward and outward from the palm [21].
• The web space of the thumb is the largest and deepest of the hand [21].
• The thumb is described as the master digit of the hand, representing the dominant element that gives value to all other digits [26].
• The hand consists of 19 bones, 17 articulations, and 19 muscles situated entirely within the hand [21].

Prosthesis Design & Biomechanics¶

• The Touch® prosthesis reproduces the concept of dual mobility consisting of a mobile prosthetic head in a polyethylene insert that is freely moveable within a metal cup [13].
• The Touch® prosthesis comprises two concentric articulations: a smaller articulation between the head and polyethylene insert, and a larger articulation between the polyethylene insert and metal cup [13].
• The Touch® prosthesis utilizes metal-on-polyethylene bearings [13].
• The Touch® prosthesis is modular, composed of a titanium alloy stem (Ti–6Al–4 V), an M30 stainless steel intermediate implant, and an M30 stainless steel hemispheric cup [13].
• The Touch® prosthesis head is covered by a pre-assembled high-density 7-mm diameter polyethylene insert [13].
• Implant fixation for the Touch® prosthesis is achieved by a press-fit effect and a double-layer porous titanium and hydroxyapatite coating that promotes osteointegration [13].
• The total in vitro range of motion of the Touch® prosthesis is 117 degrees [13].

Pathophysiology & Complications¶

• Aseptic cup loosening is cited as the most common reason for implant failure in thumb carpometacarpal joint replacement, leading to revision rates of 42%–51% [15].
• Proximal migration of the thumb is a major drawback of resection-suspension arthroplasty that can lead to compromised pinch strength and disability [15].
• Polyethylene liner fracture in the Touch prosthesis can present as persistent clicking during thumb motion without antecedent trauma or pain [11].
• Standard radiographs and CT scans may show a well-aligned implant without evidence of loosening in cases of polyethylene liner fracture [11].
• Stress-view imaging (dynamic x-ray) using a fluoroscopic image intensifier can reveal instability of the carpometacarpal I joint and decentralization of the head compared with the cup in cases of polyethylene liner fracture [11].
• Dynamic radiographic imaging with longitudinal traction is important for making a timely diagnosis of polyethylene liner fracture when standard radiographs are normal [14].
• Revision surgery for polyethylene liner fracture involves exchanging only the liner, which restores stability [11].

Classification¶

• The Touch® prosthesis reproduces the original concept of dual mobility as defined by Gilles Bousquet for a total hip prosthesis [13].
• The Touch® prosthesis consists of a mobile prosthetic head in a polyethylene insert that is freely moveable within a metal cup [13].
• The Touch® prosthesis was developed in 2013 based on the principle of a ball-and-socket joint with three degrees of freedom [13].
• The Touch® prosthesis is modular and composed of a titanium alloy stem (Ti–6Al–4 V) available in five sizes [13].
• The Touch® prosthesis includes an M30 stainless steel intermediate implant with a 4-mm diameter head covered by a pre-assembled high-density 7-mm diameter polyethylene insert [13].
• The Touch® prosthesis polyethylene insert is available in three lengths and two angles [13].
• The Touch® prosthesis includes an M30 stainless steel hemispheric cup available in two sizes (9 and 10 mm in diameter) [13].
• Implant fixation for the Touch® prosthesis is primary by a press-fit effect and secondary by means of a double-layer porous titanium and hydroxyapatite coating [13].
• The double-layer porous titanium and hydroxyapatite coating promotes and accelerates osteointegration [13].
• The total in vitro range of motion of the Touch® prosthesis is 117° [13].

Clinical Presentation¶

• Persistent clicking during thumb motion without antecedent trauma or pain can be a clinical sign of polyethylene liner fracture in a Touch prosthesis [11].
• Grip and pinch strength may remain clinically unchanged compared with the contralateral side despite the presence of a fractured polyethylene liner [11].
• Standard radiographs may appear normal in cases of polyethylene liner fracture, failing to reveal the diagnosis [14].
• Computed tomography (CT) scans may demonstrate a well-aligned implant without evidence of loosening even when a polyethylene liner fracture is present [11].
• Stress-view imaging using a fluoroscopic image intensifier can reveal instability of the carpometacarpal I joint during the application of translatory stress forces on the thumb [11].
• Stress-view imaging may show a hint of possible decentralization of the prosthetic head compared with the cup in cases of polyethylene liner fracture [11].

Investigations¶

• A careful physical examination is essential to direct care and future testing if indicated [17].

Treatment¶

Prosthetic Design and Mechanics¶

• The Touch® prosthesis cup is available in two sizes: 9 and 10 mm in diameter [13].
• Implant fixation for the Touch® prosthesis is primary by a press-fit effect and secondary by a double-layer porous titanium and hydroxyapatite coating [13].

Clinical Outcomes and Survival¶

• Trapeziometacarpal prosthesis enhances function, thumb length, and patient recovery [2].
• Total joint arthroplasty in primary trapeziometacarpal joint arthritis results in low pain levels, excellent mobility and clinical function with high patient satisfaction [7].
• The Elektra prosthesis for trapeziometacarpal osteoarthritis has a revision rate of 44% after 72 months [1].
• The Elektra prosthesis for trapeziometacarpal osteoarthritis is not recommended due to poor outcomes after only 2 years [6].
• MAÏA TMC joint prosthesis is a reliable long-term surgical procedure for TMC joint osteoarthritis, improving overall function beyond 10 years [19].
• The Moovis prosthesis is recommended for the treatment of advanced trapeziometacarpal osteoarthritis for people having an activity without too many manual constraints [5].

Complications and Technical Considerations¶

• A fracture of the polyethylene liner in a Touch trapeziometacarpal prosthesis can present as persistent clicking during thumb motion without antecedent trauma or pain [11].
• Stress-view imaging using a fluoroscopic image intensifier can reveal instability of the carpometacarpal I joint and possible decentralization of the head compared with the cup in cases of suspected polyethylene liner fracture [11].
• Exchanging only the polyethylene liner restores stability after a liner fracture in a Touch prosthesis [11].
• Correct implant position can lead to reliable medium-term results after trapeziometacarpal joint arthroplasty with unconstrained cups [9].
• Attentive reaming of the trapezium and careful cup impaction are crucial steps to avoid trapezial fracture and early cup failure in Moovis arthroplasty [12].
• Scaphometacarpal arthroplasty using a trapeziometacarpal prosthesis is not sufficiently reliable to be a routine solution for surgical revision of failed TMC arthroplasty or trapeziectomy [16].
• Scaphometacarpal arthroplasty using a trapeziometacarpal prosthesis should be used with caution, primarily as a salvage solution if no safer alternative is available [16].
• Aseptic cup loosening is the most common reason for implant failure in replacement arthroplasty, leading to revision rates of 42%–51% [15].

Complications¶

Polyethylene Liner Fracture¶

• A 53-year-old male professional cook developed persistent clicking during thumb motion 12 months after Touch trapeziometacarpal arthroplasty for primary osteoarthritis [11].
• Standard radiographs and CT scans in a patient with suspected polyethylene liner fracture may show a well-aligned implant without evidence of loosening [11].
• Stress-view imaging using a fluoroscopic image intensifier can reveal instability of the carpometacarpal I joint and possible decentralization of the head compared with the cup when standard radiographs are normal [11].
• Revision surgery for a suspected polyethylene liner fracture may confirm a fractured PE liner with an intact metallic head and stem [11].
• Exchanging only the polyethylene liner can restore stability in cases of Touch prosthesis liner fracture [11].

Implant Survival and Revision¶

• The Elektra prosthesis for trapeziometacarpal osteoarthritis had a revision rate of 44% after 72 months in a follow-up of 39 consecutive cases [1].
• The Touch trapeziometacarpal joint arthroplasty reported a 96% implant survival rate at 2 years [4].
• Aseptic cup loosening is cited as the most common reason for implant failure in thumb carpometacarpal replacement arthroplasty, leading to revision rates of 42%–51% [15].

Operative Complications and Technical Considerations¶

• Attentive reaming of the trapezium and careful cup impaction are crucial steps to avoid trapezial fracture and early cup failure in Moovis trapeziometacarpal joint arthroplasty [12].

Alternative Indications and Salvage¶

Recovery¶

• Attentive reaming of the trapezium and careful cup impaction are crucial steps to avoid trapezial fracture and early cup failure [12].
• Correct implant position can lead to reliable medium-term results after trapeziometacarpal joint arthroplasty [9].
• Exchanging only the liner restores stability following a polyethylene liner fracture in a Touch trapeziometacarpal prosthesis [11].

Key Evidence¶

• [L4] Although the study observed fast pain relief, maintenance of mobility, and a gradual increase in grip strength, there was an increasing need for revision with a rate of 44% after 72 months. [1] (10.1177/1753193412443501)
• [L3] Trapeziometacarpal prosthesis shows promise for TMC arthrosis, enhancing function, thumb length, and patient recovery, warranting further research and x-ray guidance. [2] (10.1016/j.jhsg.2024.03.004)
• [L5] Limiting the magnitude of thumb loads after arthroplasty may contribute positively to the longevity of this procedure. [3] (10.1177/1753193416659230)
• [L4] The study reports a 96% implant survival rate at 2 years with promising patient-reported and clinical outcomes, leading the authors to recommend surgery with the TouchRV prosthesis as the standard treatment for patients with isolated trapeziometacarpal joint osteoarthritis. [4] (10.1177/17531934231179581)
• [L4] The absence of prosthesis instability encourages us to recommend this technique for the treatment of advanced trapeziometacarpal osteoarthritis for people having an activity without too many manual constraints. [5] (10.1177/1558944718797341)
• [L3] Because of these poor outcomes after only 2 years, the authors cannot recommend this implant. [6] (10.1177/1753193411414505)
• [L3] Total joint arthroplasty in primary trapeziometacarpal joint arthritis results in low pain levels, excellent mobility and clinical function with high patient satisfaction. [7] (10.1186/s12891-024-07439-5)
• [L4] The MAÏA trapeziometacarpal prosthesis represents a long-term solution for surgical treatment of thumb rhizarthrosis. [8] (10.1177/17531934221136442)
• [L4] This study shows that correct implant position can lead to reliable medium-term results after trapeziometacarpal joint arthroplasty. [9] (10.1177/1753193417741237)
• [L4] MAÏA TMC total joint arthroplasty may be a reliable treatment option for TMC joint osteoarthritis, with very good results for pain relief, strength, mobility, and restoration of the thumb length, providing correction of most thumb z-deformities. [10] (10.1016/j.jhsa.2017.06.008)
• [L5] [11] (10.1016/j.jhsg.2026.101045)
• [L2] Attentive reaming of the trapezium and careful cup impaction are crucial steps to avoid trapezial fracture and early cup failure. [12] (10.1177/1753193420921307)
• [L4] [13] (10.1177/17531934211024500)
• [L4] This case highlights the importance of dynamic radiographic imaging with longitudinal traction to make a timely diagnosis of polyethylene liner fracture when standard radiographs are normal. [14] (10.1177/17531934241227918)
• [L3] [15] (10.1177/1753193419873230)
• [L5] Scaphometacarpal arthroplasty using a trapeziometacarpal prosthesis is not sufficiently reliable to be a routine solution for surgical revision of failed TMC arthroplasty or trapeziectomy; instead, it should be used with caution, primarily as a salvage solution if no safer alternative is available. [16] (10.1177/17531934231201914)
• [L4] MAÏA TMC joint prosthesis is a reliable long-term surgical procedure for TMC joint osteoarthritis, improving overall function beyond 10 years. [19] (10.1016/j.jhsa.2024.03.019)

References¶

[1] Elektra prosthesis for trapeziometacarpal osteoarthritis: a follow-up of 39 consecutive cases. Journal of Hand Surgery (European Volume). 2012. DOI: 10.1177/1753193412443501

[2] Comparative Analysis of Prosthetic (Touch) and Arthroplastic Surgeries for Trapeziometacarpal Arthrosis: Functional Outcomes and Patient Satisfaction With a 2-Year Follow-Up. Journal of Hand Surgery Global Online. 2024. DOI: 10.1016/j.jhsg.2024.03.004

[3] Total arthroplasty of basal thumb joint with Elektra prothesis: an in vitro analysis. Journal of Hand Surgery (European Volume). 2016. DOI: 10.1177/1753193416659230

[4] Low complication rate and high implant survival at 2 years after Touch® trapeziometacarpal joint arthroplasty. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934231179581

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

[6] Two-year outcomes of Elektra prosthesis for trapeziometacarpal osteoarthritis: a longitudinal cohort study. Journal of Hand Surgery (European Volume). 2012. DOI: 10.1177/1753193411414505

[7] Mid- and long-term clinical results of the Elektra and Moovis prosthesis for trapeziometacarpal joint replacement. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07439-5

[8] Long-term survival analysis of 191 MAÏA® prostheses for trapeziometacarpal arthritis. Journal of Hand Surgery (European Volume). 2022. DOI: 10.1177/17531934221136442

[9] Can surgical guidelines minimize complications after Maïa® trapeziometacarpal joint arthroplasty with unconstrained cups?. Journal of Hand Surgery (European Volume). 2017. DOI: 10.1177/1753193417741237

[10] MAÏA Trapeziometacarpal Joint Arthroplasty: Clinical and Radiological Outcomes of 80 Patients With More than 6 Years of Follow-Up. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.06.008

[11] Polyethylene Liner Fracture in Touch Trapeziometacarpal Prosthesis: A Case Report. Journal of Hand Surgery Global Online. 2026. DOI: 10.1016/j.jhsg.2026.101045

[12] Two-year results of the Moovis trapeziometacarpal joint arthroplasty with focus on early complications. Journal of Hand Surgery (European Volume). 2020. DOI: 10.1177/1753193420921307

[13] Dual mobility trapeziometacarpal prosthesis: a prospective study of 107 cases with a follow-up of more than 3 years. Journal of Hand Surgery (European Volume). 2021. DOI: 10.1177/17531934211024500

[14] Polyethylene liner fracture in dual mobility trapeziometacarpal total joint replacement: how to make a timely diagnosis?. Journal of Hand Surgery (European Volume). 2024. DOI: 10.1177/17531934241227918

[15] Elektra prosthesis versus resection-suspension arthroplasty for thumb carpometacarpal osteoarthritis: a long-term cohort study. Journal of Hand Surgery (European Volume). 2019. DOI: 10.1177/1753193419873230

[16] Scaphometacarpal arthroplasty with a TOUCH® prosthesis: feasibility and biomechanical impact in a cadaver model. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934231201914

[17] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Anatomy, Evaluation, Clinical Examination, and Imaging > Evaluation and Clinical Examination: Current Concepts.

[19] MAÏA Trapeziometacarpal Joint Arthroplasty: Clinical and Radiological Outcomes of 76 Patients With More Than 10 Years of Follow-Up. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2024.03.019

[21] Exam Of The Hand Wrist 2Ed. INTRODUCTION.

[26] Exam Of The Hand Wrist 2Ed. The arches of the hand > The metacarpal arch.