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Thay khớp ngón tay cái Touch

Updated Oct 2026
Một bức vẽ tay mô tả bàn tay đang kẹp một vật giữa ngón cái và ngón tay một cách thoải mái.
Phẫu thuật thay khớp ngón cái Touch thay mới bề mặt khớp ở gốc ngón tay cái, là khớp bị hao mòn trong bệnh viêm khớp gốc ngón cái, giúp bạn cầm nắm bằng ngón cái và ngón trỏ thoải mái trở lại. Kieran Hirpara 4.0

Trang này được dịch bằng máy và chưa được bác sĩ kiểm tra. Bản tiếng Anh là bản chính thức.

Lý do phẫu thuật này được đề xuất

Bác sĩ Kieran Hirpara, bác sĩ phẫu thuật chi trên tại Bệnh viện tư nhân Mater Rockhampton, sẽ bắt đầu bằng các phương pháp ít xâm lấn nhất phù hợp với tình trạng của bạn. Thông thường, bệnh nhân được bác sĩ đa khoa giới thiệu đến phòng khám chúng tôi; nếu vật lý trị liệu viên khuyên bạn nên đến gặp chúng tôi, bạn vẫn cần có giấy giới thiệu từ bác sĩ đa khoa để được hưởng mức hoàn trả từ chương trình Medicare. Trong buổi khám, chúng tôi sẽ hỏi bệnh sử, khám tay bạn và chỉ định chụp hình ảnh nếu cần thiết để xác nhận chẩn đoán.

Viêm khớp do hao mòn ở vùng gốc ngón tay cái là nguyên nhân thường gặp gây đau và yếu tay. Bệnh có thể khiến các động tác kẹp, nắm và xoay chìa khóa trở nên khó khăn. Thông thường chúng tôi sẽ thử các phương pháp điều trị không phẫu thuật trước, chẳng hạn như thay đổi cách bạn sử dụng tay, trị liệu tay và đeo nẹp. Phẫu thuật được cân nhắc khi các biện pháp này không mang lại đủ cải thiện cho bạn.

Ca phẫu thuật này, phẫu thuật thay khớp ngón tay cái, là việc thay thế khớp bị hao mòn ở gốc ngón tay cái bằng một khớp nhân tạo. Phương pháp này thường được áp dụng cho những người bị viêm khớp chỉ giới hạn ở khớp này và cơn đau không thuyên giảm với các phương pháp điều trị không phẫu thuật. Chúng tôi có thể đã đề xuất phương pháp này cho bạn vì mục đích của nó là giảm đau, khôi phục khả năng vận động, sức mạnh và độ vững, để bạn có thể tự tin sử dụng ngón tay cái. Hầu hết khớp nhân tạo Touch vẫn còn tại chỗ sau 2 năm, với tỷ lệ khớp nhân tạo còn tồn tại (chưa phải thay hoặc tháo) được ghi nhận là 96%. Việc ca phẫu thuật này có phù hợp với bạn hay không là quyết định mà chúng ta cùng nhau đưa ra.

Trước khi phẫu thuật

Trong những tuần trước phẫu thuật, chúng tôi sẽ xác nhận kế hoạch bằng chẩn đoán hình ảnh ngón tay cái, chẳng hạn như chụp X-quang, MRI hoặc siêu âm. Những hình ảnh này cho thấy khớp bị hao mòn và giúp chúng tôi lên kế hoạch thay khớp. Đội ngũ của chúng tôi sẽ hướng dẫn rõ ràng cho bạn về việc chuẩn bị. Bạn sẽ cần ngừng ăn và uống bảy giờ trước ca phẫu thuật. Chúng tôi yêu cầu bảy giờ thay vì sáu giờ để có thể đưa ca mổ của bạn lên sớm hơn nếu danh sách các ca mổ được hoàn thành trước giờ dự kiến. Một số loại thuốc cần được tạm ngừng, và chúng tôi sẽ cho bạn biết đó là thuốc nào và ngừng khi nào. Hãy mang theo danh sách các loại thuốc bạn đang dùng. Hãy sắp xếp người đưa bạn về nhà sau phẫu thuật. Hãy mặc quần áo rộng rãi, thoải mái. Nếu bạn mắc các bệnh lý khác, có thể bạn sẽ cần làm xét nghiệm máu hoặc gặp bác sĩ gây mê.

Vào ngày phẫu thuật

Vào ngày phẫu thuật, bạn sẽ đến khu vực tiếp nhận bệnh nhân phẫu thuật của bệnh viện. Tại đây, bạn sẽ được làm thủ tục nhập viện và chuẩn bị cho ca mổ. Bạn sẽ gặp bác sĩ gây mê – bác sĩ chăm lo cho giấc ngủ và sự thoải mái của bạn trong suốt ca phẫu thuật. Ca phẫu thuật này được thực hiện dưới gây mê toàn thân. Bạn sẽ hoàn toàn ngủ say trong suốt quá trình phẫu thuật. Một số bệnh nhân có thể được tiêm thuốc tê vùng để giảm đau sau mổ; quyết định này do bác sĩ gây mê đưa ra vào ngày phẫu thuật tùy theo tình trạng cụ thể của từng người.

Sau đó, bạn sẽ được đưa vào phòng mổ để tiến hành ca phẫu thuật. Sau ca mổ, bạn sẽ tỉnh dậy tại khu vực hồi sức, nơi các điều dưỡng theo dõi bạn cho đến khi thuốc gây mê hết tác dụng. Khi sức khỏe ổn định, bạn sẽ được chuyển về phòng bệnh hoặc xuất viện, tùy thuộc vào loại phẫu thuật và tiến triển hồi phục của bạn.

Quy trình phẫu thuật

Bác sĩ phẫu thuật sẽ rạch một đường duy nhất ở vùng gốc ngón tay cái để tiếp cận khớp bị hao mòn. Các bề mặt khớp bị hư hỏng sẽ được loại bỏ và thay thế bằng các bộ phận nhân tạo: một chuôi nhỏ được đặt vào xương ngón tay cái và một ổ cối (cup) được lắp vào xương nhỏ nằm ngay bên cạnh. Các bộ phận mới được thiết kế để chuyển động áp vào nhau giống như một khớp khỏe mạnh, nhờ đó bạn có thể kẹp và nắm trở lại.

Mục tiêu là giữ cho ngón tay cái có chiều dài và độ thẳng hàng tự nhiên, giúp ngón tay cái trông và hoạt động gần với bình thường nhất có thể. Vì khớp được thay thế chứ không bị loại bỏ, các cơ và gân giúp cử động ngón tay cái không phải làm việc nhiều để tạo ra động tác kẹp.

Khi khớp nhân tạo đã được đặt vào, bác sĩ phẫu thuật sẽ khâu đóng vết mổ và băng lại. Khi tỉnh dậy, ngón tay cái của bạn sẽ được băng kín, và băng gạc được giữ nguyên trong khoảng 10 ngày.

Sau đó, một chuyên gia trị liệu tay sẽ hướng dẫn quá trình hồi phục của bạn. Họ chỉ cho bạn cách cử động và sử dụng ngón tay cái trong khi khớp lành lại, và hướng dẫn khi nào bạn được nâng đồ vật và được nâng nặng đến mức nào. Tránh để khớp mới phải chịu tải nặng sẽ giúp khớp bền lâu.

Sau phẫu thuật

Hầu hết bệnh nhân sẽ ở lại bệnh viện một đêm sau ca phẫu thuật này; tuy nhiên một số người có thể về nhà ngay trong ngày. Bạn sẽ tỉnh dậy tại khu vực hồi sức, sau đó được chuyển về phòng bệnh. Các điều dưỡng sẽ kiểm tra mức độ đau và cho bạn dùng thuốc để bạn cảm thấy dễ chịu. Ngón tay cái của bạn sẽ được quấn băng gạc và đỡ bằng nẹp. Hãy kê tay cao trên gối khi nghỉ ngơi; điều này giúp giảm sưng. Bạn có thể đứng dậy và đi lại trong khu phòng bệnh, và bạn sẽ dùng tay còn lại cho hầu hết các việc. Vui lòng sắp xếp để có người ở cùng bạn tại nhà trong 24 giờ đầu. Chúng tôi để băng gạc trên vết thương khoảng 10 ngày; xin đừng tháo nó ra trước thời hạn đó trừ khi chúng tôi yêu cầu. Chúng tôi sẽ thay hoặc gỡ băng gạc khi khám lại cho bạn.

Quá trình hồi phục

Trong vài ngày đầu, ngón tay cái của bạn sẽ đau nhức và sưng tấy. Kê tay cao trên gối sẽ giúp giảm sưng. Thuốc giảm đau thông thường, dùng theo chỉ dẫn, sẽ giúp bạn dễ chịu trong khi giai đoạn khó chịu nhất qua đi.

Bạn sẽ về nhà với ngón tay cái được đeo nẹp, và băng gạc được giữ nguyên trong khoảng 10 ngày. Trị liệu tay sau phẫu thuật được thực hiện với Ruby Doolan tại Extend Rehabilitation. Ruby là chuyên gia trị liệu tay: cô ấy hướng dẫn bạn các bài tập nhẹ nhàng để giữ cho các ngón tay cử động trong khi khớp mới lành lại, và làm bất kỳ loại nẹp nào bạn cần trong quá trình ngón tay cái hồi phục. Cô ấy cũng hướng dẫn khi nào bạn được nâng đồ vật và được nâng nặng đến mức nào, vì tránh để khớp mới phải chịu tải nặng sẽ giúp khớp bền lâu.

Trong sinh hoạt hằng ngày, lúc đầu bạn sẽ dùng tay còn lại cho hầu hết các việc. Bạn không được lái xe khi vẫn đang đeo nẹp, vì nẹp sẽ ngăn cản việc nắm chặt vô lăng một cách an toàn. Khi nẹp đã được tháo ra và bác sĩ phẫu thuật cho phép, bạn mới có thể bắt đầu lái xe; hãy xem trang của chúng tôi về Lái xe sau phẫu thuật chi trên. Khi tình trạng sưng giảm dần và khả năng cử động trở lại, bạn sẽ bắt đầu dùng ngón tay cái cho các việc nhẹ hằng ngày, rồi tăng dần đến việc nắm và kẹp mà không đau.

Quá trình hồi phục khác nhau ở mỗi người. Lịch trình của bạn có thể khác, và bác sĩ phẫu thuật cùng chuyên gia trị liệu tay sẽ hướng dẫn bạn ở từng bước.

Những biến chứng có thể xảy ra

Hầu hết bệnh nhân đều hồi phục tốt, nhưng đôi khi vẫn có thể gặp phải các vấn đề. Bác sĩ phẫu thuật và đội ngũ y tế sẽ theo dõi sát sao để phát hiện sớm bất kỳ bất thường nào.

Các bộ phận của khớp mới đôi khi có thể bị lỏng. Tình trạng này thường gây cảm giác đau sâu, âm ỉ ở vùng gốc ngón tay cái, quay trở lại hoặc nặng hơn sau một thời gian đã đỡ đau. Nếu ngón tay cái của bạn đau trở lại vài tuần hoặc vài tháng sau phẫu thuật, hãy gọi cho phòng khám để chúng tôi sắp xếp chụp hình ảnh và xem điều gì đang xảy ra.

Khớp cũng có thể bị trật, nghĩa là các bộ phận mới trượt ra khỏi vị trí. Bạn sẽ cảm thấy một tiếng "cục" đột ngột, sau đó là đau và ngón tay cái không cử động bình thường được. Hãy gọi ngay cho phòng khám nếu điều này xảy ra.

Gãy một trong các xương nhỏ quanh khớp mới có thể xảy ra trong hoặc sau phẫu thuật. Tình trạng này gây đau nhói và sưng nặng hơn nhiều so với dự kiến. Hãy gọi cho phòng khám để chúng tôi kiểm tra.

Các dây thần kinh gần ngón tay cái có thể bị kích thích hoặc bầm dập. Bạn có thể nhận thấy ngứa ran, cảm giác kiến bò hoặc tê ở mặt sau ngón tay cái. Tê và yếu trong 24 giờ đầu sau khi tiêm thuốc tê vùng là điều bình thường. Khi thuốc tê vùng đã hết tác dụng, hãy gọi cho phòng khám nếu cảm giác tê vẫn còn hoặc bạn không thể cử động ngón tay cái hay các ngón tay.

Nhiễm trùng tuy ít gặp nhưng nghiêm trọng. Hãy gọi cho phòng khám ngay trong ngày nếu bạn bị sốt, vùng da đỏ lan rộng ra từ vết mổ, hoặc có dịch hay mủ rỉ ra từ vết mổ. Hãy đến phòng cấp cứu nếu ngón tay cái chuyển sang nhợt nhạt, lạnh, trắng, xanh tím hoặc sẫm màu, vì đây có thể là vấn đề về tuần hoàn máu.

Một số bệnh nhân bị đau và nhạy cảm kéo dài ở bàn tay sau phẫu thuật, đôi khi kèm theo sưng và thay đổi màu sắc hoặc nhiệt độ của da. Nếu cơn đau tiếp tục nặng hơn dù đã dùng thuốc giảm đau, hãy gọi cho phòng khám ngay trong ngày.

Nếu khớp mới không đạt kết quả như mong muốn, đôi khi cần phẫu thuật thêm. Điều này có thể là sửa lại hoặc thay khớp nhân tạo, hoặc chuyển sang một phương pháp phẫu thuật khác, trong đó khớp bị hao mòn được loại bỏ và khoảng trống được đệm bằng chính mô của bạn. Chúng tôi sẽ cùng bạn trao đổi về các lựa chọn nếu tình huống này xảy ra.

Bảng liệt kê các biến chứng ở trang này nêu rõ tỷ lệ xảy ra của từng vấn đề nếu bạn muốn biết chi tiết.

Khi nào nên gọi cho chúng tôi

Hầu hết các vấn đề xuất hiện sớm, và chúng tôi muốn được biết về chúng càng sớm càng tốt. Hãy gọi cho phòng khám ngay trong ngày nếu bạn bị sốt, vùng da đỏ lan rộng ra từ vết mổ, hoặc có dịch hay mủ rỉ ra từ vết mổ, hoặc nếu cơn đau tiếp tục nặng hơn dù đã dùng thuốc giảm đau. Hãy gọi cho chúng tôi nếu cảm giác tê vẫn còn hoặc bạn không thể cử động ngón tay cái hay các ngón tay sau khi thuốc tê vùng đã hết tác dụng, tức là khoảng 24 giờ sau phẫu thuật. Hãy đến phòng cấp cứu nếu bạn bị sưng hoặc đau bắp chân, khó thở hoặc đau ngực, vì đây có thể là dấu hiệu của huyết khối. Cũng hãy đến phòng cấp cứu nếu ngón tay cái của bạn chuyển sang nhợt nhạt, lạnh, trắng, xanh tím hoặc sẫm màu. Nếu bạn không thể liên lạc với phòng khám ngoài giờ làm việc hoặc vào cuối tuần, hãy đến khoa cấp cứu gần nhất.

Nơi để tìm đọc thêm thông tin về bệnh lý

Trang này chỉ đề cập đến phương pháp phẫu thuật. Các thông tin chi tiết về bệnh lý được điều trị, bao gồm cả những bằng chứng cho thấy khi nào phẫu thuật có ích và khi nào không, đều được trình bày kỹ lưỡng hơn trên trang Viêm khớp ngón tay cái.


Evidence & references

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 Touch® trapeziometacarpal joint arthroplasty demonstrated a 96% implant survival rate at 2 years [4].
  • The Touch® prosthesis is recommended as the standard treatment for patients with isolated trapeziometacarpal joint osteoarthritis [4].
  • The Touch1 prosthesis is a safe and stable implant providing good satisfaction and very good functional scores [7].
  • Patients using the Touch1 prosthesis experience a fast return to work and leisure activity [7].
  • Trapeziometacarpal prosthesis enhances function, thumb length, and patient recovery [2].
  • Total joint arthroplasty for primary trapeziometacarpal joint arthritis results in low pain levels, excellent mobility, and high patient satisfaction [10].
  • The MAÏA trapeziometacarpal prosthesis is a reliable long-term surgical procedure that improves overall function beyond 10 years [23].
  • The MAÏA TMC total joint arthroplasty provides very good results for pain relief, strength, mobility, and restoration of thumb length [13].
  • The MAÏA TMC total joint arthroplasty provides correction of most thumb z-deformities [13].
  • The Elektra prosthesis had a revision rate of 44% after 72 months [1].
  • The Elektra prosthesis is not recommended due to poor outcomes observed after only 2 years [8].
  • The main complication for the Elektra prosthesis was loosening, with a rate never dropping below 17% at 4 years [9].
  • The Moovis prosthesis is recommended for the treatment of advanced trapeziometacarpal osteoarthritis in patients without too many manual constraints [5].
  • Dual mobility arthroplasty for thumb CMC joint osteoarthritis is a satisfactory solution with good functional results and absence of early and middle term dislocations [12].
  • The Ivory arthroplasty is a reliable option for treating advanced trapeziometacarpal osteoarthritis, providing important improvement in overall function and pain reduction [15].
  • Not every complication associated with the Ivory prosthesis requires surgical revision [14].
  • Correct implant position leads to reliable medium-term results after trapeziometacarpal joint arthroplasty [11].
  • Limiting the magnitude of thumb loads after arthroplasty may contribute positively to the longevity of the procedure [3].
  • Scaphometacarpal arthroplasty using a trapeziometacarpal prosthesis is not sufficiently reliable to be a routine solution for surgical revision of failed TMC arthroplasty or trapeziectomy [21].
  • Scaphometacarpal arthroplasty using a trapeziometacarpal prosthesis should be used with caution, primarily as a salvage solution if no safer alternative is available [21].
  • The Touch® prosthesis is compatible with the Ivory® trapeziometacarpal prosthesis stem during revision surgery [16].
  • If the trial neck does not align with the centre of the trapezium, the cup position should be dictated by the neck to represent the new centre of rotation [17].

Anatomy & Pathophysiology

Bony Anatomy

  • The skeleton of the hand consists of 27 bones, of which 19 are long bones [30].
  • The radial ray or first ray is the shortest and is made up of only three bones: a metacarpal and two phalanges [30].
  • The trapezium is clearly angled out in front of the carpal plane so that the first metacarpal makes an angle of about 45 degrees with the second metacarpal in the sagittal plane [30].
  • The thumb metacarpal is independent and articulates with the trapezium [36].
  • The base of each metacarpal articulates with the distal row of the carpus [30].
  • The thumb ray continues the external column of the carpus formed by the scaphoid and trapezium [30].

Joint Mechanics & Kinematics

  • The trapeziometacarpal joint has a saddle shape in opposing planes of the articular surfaces [30].
  • The first metacarpal makes an angle of about 45 degrees with the second metacarpal in the sagittal plane, which explains the gap between the first ray and the palm [30].
  • The thumb ray is more mobile, shorter, and more proximal than the other rays, allowing it to project in front of the plane of the palm to oppose itself to the other four rays [30].
  • The wrist has three axes of movement, permitting the hand to be positioned in any spatial configuration [30].
  • The combined movements of the wrist and forearm place the hand in a position for grasping [31].
  • The thumb has a more proximal and lateral position, allowing movement inward and outward from the palm [31].

Musculature & Tendon Anatomy

  • The first (most radial) extensor compartment contains the abductor pollicis longus and the extensor pollicis brevis [29].
  • The abductor pollicis longus inserts at the base of the thumb metacarpal and radially abducts the thumb [29].
  • The extensor pollicis brevis inserts on the dorsum of the proximal aspect of the proximal phalanx of the thumb and actively extends the metacarpophalangeal joint of the thumb [29].
  • The extensor pollicis longus runs longitudinally down the forearm through the third compartment and turns abruptly radialward about Lister tubercle [29].
  • The extensor pollicis longus inserts on the distal phalanx and provides forceful extension of the thumb interphalangeal joint [29].
  • The flexor pollicis longus originates from two heads: a radial head from the proximal radius and interosseous membrane, and an accessory head from the coronoid process of the ulna and medial epicondyle of the humerus [40].
  • The flexor pollicis longus inserts into the proximal base of the thumb distal phalanx and is innervated by the anterior interosseous branch of the median nerve [40].
  • The flexor pollicis longus flexes both the interphalangeal and metacarpophalangeal joints of the thumb [40].
  • The tenosynovial sheath of the flexor pollicis longus is continuous with the radial bursa [40].

Vascular Anatomy

  • The "princeps pollicis" artery, a terminal branch of the radial artery, crosses the first intermetacarpal space and runs along the ulnar side of the first metacarpal bone [37].
  • The princeps pollicis artery emerges onto the subcutaneous palmar tissue at the level of the cutaneous flexion crease of the metacarpophalangeal joint [37].
  • The princeps pollicis artery divides into two terminal rami, the collateral palmar arteries of the thumb, which run along the digital tunnel symmetrically [37].
  • An arcade located deep in the flexor tendon joins together the two palmar arteries at the level of the distal metaphysis of the first phalanx [37].
  • The dorsal arteries of the thumb originate from terminal branches of the radial artery at the level of the anatomical snuff-box [37].
  • The posterior area of the thumb is vascularized by two arteries which originate from the palmar arteries at the level of the first metacarpal [37].

Soft Tissue & Skin Anatomy

  • The superficial palmar fascia covers a triangular area of the central palm, with no central band for the thumb [43].
  • The dorsal skin of the hand is thin and possesses loose connections with deeper planes, allowing free gliding [42].
  • The palmar integument is subdivided into two separate zones by the oppositional crease of the thumb [32].
  • The skin of the radial portion of the palm covers the thenar eminence and is the mobile portion [32].
  • The skin of the ulnar and distal portion covers the hypothenar eminence where the skin has poor mobility [32].
  • The web spaces are formed from the union of two nonsymmetrical cutaneous surfaces, with the palmar surface being flat and densely adherent to the commissural skeleton [32].
  • The distal transverse ligament at the level of the thumb web is the deepest and most mobile commissural skeleton [32].

Prosthesis Design & Biomechanics

  • The Touch® prosthesis consists of a mobile prosthetic head in a polyethylene insert that is freely moveable within a metal cup [22].
  • 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 [22].
  • The Touch® prosthesis uses metal-on-polyethylene bearings [22].
  • 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 [22].
  • The Touch® prosthesis head has a 4-mm diameter covered by a pre-assembled high-density 7-mm diameter polyethylene insert [22].
  • The Touch® prosthesis cup is available in two sizes: 9 and 10 mm in diameter [22].
  • 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 [22].
  • The total in vitro range of motion of the Touch® prosthesis is 117 degrees [22].

Classification

  • The Touch® prosthesis reproduces the dual mobility concept consisting of a mobile prosthetic head in a polyethylene insert that is freely moveable within a metal cup [22].
  • The Touch® prosthesis utilizes metal-on-polyethylene bearings [22].
  • The Touch® prosthesis stem is available in five sizes [22].
  • The Touch® prosthesis intermediate implant has a 4-mm diameter head covered by a pre-assembled high-density 7-mm diameter polyethylene insert [22].
  • The Touch® prosthesis polyethylene insert is available in three lengths and two angles [22].
  • The Touch® prosthesis hemispheric cup is available in two sizes: 9 and 10 mm in diameter [22].
  • The double-layer porous titanium and hydroxyapatite coating promotes and accelerates osteointegration [22].

Clinical Presentation

  • A 53-year-old male professional cook presented with persistent clicking during thumb motion 12 months after Touch trapeziometacarpal arthroplasty [18].
  • The patient reported no antecedent trauma or pain associated with the clicking noise [18].
  • Grip and pinch strength were clinically evaluated and showed no difference compared with the opposite side [18].
  • Standard radiographs taken 1 year after surgery did not demonstrate loosening of the implant [18].
  • Computed tomography (CT) scan demonstrated a well-aligned implant without evidence of loosening [18].
  • CT scan revealed a hint of a very small bone cyst but no loosening of the cup [18].
  • Stress-view imaging using a fluoroscopic image intensifier revealed instability of the carpometacarpal I joint during the application of translatory stress forces on the thumb [18].
  • Stress-view imaging showed a hint of possible decentralization of the head compared with the cup [18].
  • The new diagnosis based on imaging was a fracture of the polyethylene (PE) liner [18].
  • Revision surgery confirmed a fractured PE liner with an intact metallic head and stem [18].
  • Exchanging only the liner restored stability [18].
  • Follow-up radiographs 6 weeks after revision surgery confirmed the implant position remained satisfactory [18].
  • Dynamic radiographic imaging with longitudinal traction is important for making a timely diagnosis of polyethylene liner fracture when standard radiographs are normal [20].

Investigations

  • Standard radiographs (x-ray) are used to evaluate preoperative osteoarthritis and postoperative implant position, including stem subsidence, periprosthetic radiolucent lines, osteolysis, implant fracture, polyethylene wear, periprosthetic ossifications, and prosthetic dislocation or subluxation [27].
  • Subsidence of the metacarpal component is evaluated by comparing the A/B ratio in percentage on strict lateral views immediately after surgery and at the last follow-up [27].
  • A difference of more than 25% in the A/B ratio on strict lateral views is indicative of implant subsidence [27].
  • Computed tomography (CT) scans can demonstrate a well-aligned implant without evidence of loosening even when clinical symptoms such as clicking are present [18].
  • Stress-view imaging (dynamic x-ray) using a fluoroscopic image intensifier can reveal instability of the carpometacarpal I joint and possible decentralization of the head compared with the cup during the application of translatory stress forces [18].
  • Preoperative assessment includes evaluation of the scaphotrapeziotrapezoid (STT) joint and confirmation of the absence of other thumb affections [27].
  • Osteoarthritis is assessed preoperatively on standard anteroposterior and lateral radiographic views using the Eaton classification [27].

Treatment

Implant Design and Biomechanics

  • The Touch® prosthesis head has a 4-mm diameter and is covered by a pre-assembled high-density 7-mm diameter polyethylene insert [22].

Surgical Technique

  • A dorsolateral approach is used, protecting the superficial branch of the radial nerve and artery [25].
  • The first dorsal compartment is released routinely, and the TMJ capsule is exposed between the extensor pollicis brevis and abductor pollicis longus tendons [25].
  • A complete circumferential soft tissue release of the thumb metacarpal base is performed, including resection of the volar lip to facilitate delivery of the metacarpal base out of the wound [25].
  • Osteophytes on the base of the metacarpal and the trapezium are resected to reduce the risk of impingement and dislocation [25].
  • The distal articular surface of the trapezium is cut to be parallel with the STT joint [25].
  • A K-wire is inserted under image guidance, centred in the trapezium, and the trapezium is reamed over the wire as recommended by the manufacturer [25].
  • The MAÏA® dual mobility hemispherical cup is inserted with spikes facing the four corners of the trapezium to provide rotational stability [25].
  • Attentive reaming of the trapezium and careful cup impaction are crucial steps to avoid trapezial fracture and early cup failure [19].

Clinical Outcomes and Survival

  • The Touch® prosthesis has a 96% implant survival rate at 2 years [4].
  • The Touch® prosthesis provides promising patient-reported and clinical outcomes [4].
  • Surgery with the Touch® prosthesis is recommended as the standard treatment for patients with isolated trapeziometacarpal joint osteoarthritis [4].
  • The Touch1 prosthesis allows for a fast return to work and leisure activity [7].
  • Total joint arthroplasty in primary trapeziometacarpal joint arthritis results in low pain levels, excellent mobility, and clinical function with high patient satisfaction [10].
  • The Elektra prosthesis observed fast pain relief, maintenance of mobility, and a gradual increase in grip strength [1].
  • Due to poor outcomes after only 2 years, the Elektra implant cannot be recommended [8].
  • The main complication for the Elektra prosthesis was loosening, which occurred frequently before 18 months in early versions [9].
  • The loosening rate for the Elektra prosthesis never dropped below 17% at 4 years [9].
  • The MAÏA trapeziometacarpal prosthesis represents a long-term solution for surgical treatment of thumb rhizarthrosis [6].
  • MAÏA TMC joint prosthesis is a reliable long-term surgical procedure for TMC joint osteoarthritis, improving overall function beyond 10 years [23].
  • MAêA TMC total joint arthroplasty provides very good results for pain relief, strength, mobility, and restoration of the thumb length [13].
  • MAÏA TMC total joint arthroplasty provides correction of most thumb z-deformities [13].
  • Correct implant position can lead to reliable medium-term results after trapeziometacarpal joint arthroplasty with unconstrained cups [11].
  • The Moovis prosthesis is recommended for the treatment of advanced trapeziometacarpal osteoarthritis for people having an activity without too many manual constraints [5].
  • Dual mobility arthroplasty for the thumb CMC joint osteoarthritis is a satisfactory solution with good functional results and absence of early and middle term dislocations [12].
  • The Moovis prosthesis provides very good results at 1 year for rhizarthrosis [26].
  • The Ivory arthroplasty provides improvement in overall function and pain reduction, and not every complication requires surgical revision [14].

Complications and Revision

  • Polyethylene liner fracture in the Touch prosthesis can present as persistent clicking during thumb motion without antecedent trauma or pain [18].
  • Standard radiographs may appear normal in cases of polyethylene liner fracture, while stress-view imaging reveals instability of the carpometacarpal I joint [18].
  • Revision surgery for a fractured PE liner involves exchanging only the liner, which restores stability [18].
  • Revision surgery for the Ivory® trapeziometacarpal prosthesis allows the stem to be retained due to compatibility with the Touch® prosthesis [16].
  • Clinical and radiographic follow-up at 6 months after revision surgery for the Ivory® prosthesis was uneventful [16].

Complications

Implant Failure and Loosening

  • Aseptic cup loosening is cited as the most common reason for implant failure in thumb carpometacarpal joint replacement arthroplasty [24].
  • Aseptic cup loosening leads to revision rates of 42%–51% in thumb carpometacarpal joint replacement arthroplasty [24].
  • The Elektra prosthesis had a loosening rate that never dropped below 17% at 4 years [9].
  • Loosening of the Elektra prosthesis occurred frequently before 18 months in early versions [9].
  • The Touch® trapeziometacarpal joint arthroplasty reported a 96% implant survival rate at 2 years [4].

Polyethylene Liner Fracture

  • Standard radiographs and CT scans may show a well-aligned implant without evidence of loosening in cases of polyethylene liner fracture [18].
  • 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 polyethylene liner fracture [18].
  • Revision surgery for polyethylene liner fracture in the Touch prosthesis can involve exchanging only the liner while retaining the intact metallic head and stem [18].

Intraoperative and Early Complications

  • 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 [19].
  • Osteophytes on the base of the metacarpal and the trapezium are resected to reduce the risk of impingement and dislocation during MAÏA® dual mobility CMC joint arthroplasty [25].

Instability and Dislocation

  • The Moovis prosthesis showed an absence of early and middle term dislocations in a short series of 19 cases [12].
  • The Moovis prosthesis showed an absence of prosthesis instability in a retrospective functional study of 28 prostheses [5].
  • The Touch1 prosthesis appeared to be a safe and stable implant [7].

Revision and Salvage Considerations

  • The Ivory® trapeziometacarpal prosthesis stem can be retained during revision surgery with the Touch® prosthesis [16].
  • Not every complication of the Ivory arthroplasty requires surgical revision [14].

Recovery

  • The Elektra prosthesis was associated with fast pain relief, maintenance of mobility, and a gradual increase in grip strength [1].
  • The Touch prosthesis demonstrated a 96% implant survival rate at 2 years [4].
  • The Touch prosthesis provided promising patient-reported and clinical outcomes [4].
  • The authors of the 2-year Touch study recommend surgery with the Touch prosthesis as the standard treatment for patients with isolated trapeziometacarpal joint osteoarthritis [4].
  • The Moovis prosthesis was 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 Touch prosthesis provided good satisfaction and very good functional scores [7].
  • The Touch prosthesis allowed for a fast return to work and leisure activity [7].
  • The Elektra prosthesis had poor outcomes after only 2 years, leading the authors to not recommend this implant [8].
  • Loosening was the main complication for the Elektra prosthesis, occurring frequently before 18 months in early versions [9].
  • The rate of loosening for the Elektra prosthesis never dropped below 17% at 4 years [9].
  • Correct implant position can lead to reliable medium-term results after trapeziometacarpal joint arthroplasty [11].
  • Dual mobility arthroplasty for the thumb CMC joint provided good functional results and an absence of early and middle term dislocations [12].
  • MAÏA TMC total joint arthroplasty provided very good results for pain relief, strength, mobility, and restoration of the thumb length [13].
  • MAÏA TMC total joint arthroplasty provided correction of most thumb z-deformities [13].
  • The Ivory arthroplasty resulted in an improvement in overall function and pain reduction [14].
  • Not every complication following Ivory arthroplasty requires surgical revision [14].
  • The Ivory arthroplasty is a reliable option for treating advanced trapeziometacarpal osteoarthritis, providing an important improvement in overall function and pain reduction [15].
  • A 53-year-old male professional cook developed persistent clicking during thumb motion 12 months after Touch prosthesis implantation without antecedent trauma or pain [18].
  • Grip and pinch strength were clinically evaluated and showed no difference compared with the opposite side in the patient with a fractured PE liner [18].
  • Standard radiographs and CT scans in the patient with a fractured PE liner demonstrated a well-aligned implant without evidence of loosening [18].
  • Exchanging only the liner restored stability in the patient with a fractured PE liner [18].
  • Follow-up radiographs 6 weeks after liner exchange confirmed the implant position remained satisfactory [18].
  • Dynamic radiographic imaging with longitudinal traction is important to make a timely diagnosis of polyethylene liner fracture when standard radiographs are normal [20].

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)
  • [L4] The MAÏA trapeziometacarpal prosthesis represents a long-term solution for surgical treatment of thumb rhizarthrosis. [6] (10.1177/17531934221136442)
  • [L4] The Touch1 prosthesis appeared to be a safe and stable implant, providing good satisfaction and very good functional scores and fast return to work and leisure activity. [7] (10.1016/j.hansur.2021.08.005)
  • [L3] Because of these poor outcomes after only 2 years, the authors cannot recommend this implant. [8] (10.1177/1753193411414505)
  • [L4] The main complication was loosening, which occurred frequently before 18 months in early versions, with a rate never dropping below 17% at 4 years. [9] (10.1016/j.main.2013.10.082)
  • [L3] Total joint arthroplasty in primary trapeziometacarpal joint arthritis results in low pain levels, excellent mobility and clinical function with high patient satisfaction. [10] (10.1186/s12891-024-07439-5)
  • [L4] This study shows that correct implant position can lead to reliable medium-term results after trapeziometacarpal joint arthroplasty. [11] (10.1177/1753193417741237)
  • [L4] Dual mobility arthroplasty for treatment of the thumb CMC joint osteoarthritis had proved, in this short series, to be a satisfactory solution for patients with good functional results and absence of early and middle term dislocations. [12] (10.1016/j.hansur.2017.10.128)
  • [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. [13] (10.1016/j.jhsa.2017.06.008)
  • [L3] Nevertheless, there is an improvement in overall function and pain reduction and not every complication requires surgical revision. [14] (10.1016/j.hansur.2017.10.094)
  • [L3] These long term results suggest that the Ivory arthroplasty is a reliable option for treating advanced trapeziometacarpal osteoarthritis, since it gives an important improvement in overall function and pain reduction. [15] (10.1016/j.hansur.2017.10.093)
  • [L5] Clinical and radiographic follow-up at 6 months after surgery was uneventful. [16] (10.1016/j.hansur.2020.08.003)
  • [L5] They agree that if the trial neck does not align with the centre of the trapezium, the cup position should be dictated by the neck to represent the new centre of rotation. [17] (10.1177/1753193418791435)
  • [L5] [18] (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. [19] (10.1177/1753193420921307)
  • [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. [20] (10.1177/17531934241227918)
  • [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. [21] (10.1177/17531934231201914)
  • [L4] [22] (10.1177/17531934211024500)
  • [L4] MAÏA TMC joint prosthesis is a reliable long-term surgical procedure for TMC joint osteoarthritis, improving overall function beyond 10 years. [23] (10.1016/j.jhsa.2024.03.019)
  • [L3] [24] (10.1177/1753193419873230)
  • [L4] [25] (10.1177/17531934251410360)
  • [L4] L’arthroplastie trapézométacarpienne par prothèse Moovis semble être une solution adaptée à la rhizarthrose avec de très bons résultats à 1 an. [26] (10.1016/j.main.2015.10.074)
  • [L4] [27] (10.1177/1753193420901435)

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

[7] Touch® double mobility arthroplasty for trapeziometacarpal osteoarthritis: outcomes for 92 prostheses. Hand Surgery and Rehabilitation. 2021. DOI: 10.1016/j.hansur.2021.08.005

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

[9] Complications et évolution de la prothèse trapézo-métacarpienne Elektra dans une série homogène de 1100 implants. Chirurgie de la Main. 2013. DOI: 10.1016/j.main.2013.10.082

[10] 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

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

[12] Arthroplastie par prothèse trapézo-métacarpienne Moovis – une étude fonctionnelle rétrospective de 19 cas. Hand Surgery and Rehabilitation. 2017. DOI: 10.1016/j.hansur.2017.10.128

[13] 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

[14] L’arthroplastie à rotule (Ivory[r]) comme traitement de l’arthrose trapezométacarpienne chez l’homme – le taux d’échec est-il plus élevé ?. Hand Surgery and Rehabilitation. 2017. DOI: 10.1016/j.hansur.2017.10.094

[15] Résultats de l’arthroplastie de type Ivory (r) dans le traitement de l’arthrose trapezométacarpienne avec un suivi d’au moins 10 ans – étude prospective cohorte d’un seul centre. Hand Surgery and Rehabilitation. 2017. DOI: 10.1016/j.hansur.2017.10.093

[16] Revision surgery for the Ivory® trapeziometacarpal prosthesis: compatibility with the Touch® prosthesis allows the stem to be retained. Hand Surgery and Rehabilitation. 2020. DOI: 10.1016/j.hansur.2020.08.003

[17] Letter about a Published Paper: Can surgical guidelines minimize complications after Maïa® trapeziometacarpal joint arthroplasty with unconstrained cups?. Journal of Hand Surgery (European Volume). 2018. DOI: 10.1177/1753193418791435

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

[19] 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

[20] 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

[21] 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

[22] 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

[23] 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

[24] 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

[25] Short-to-medium-term outcomes of MAÏA® dual mobility CMC joint arthroplasty. Journal of Hand Surgery (European Volume). 2026. DOI: 10.1177/17531934251410360

[26] Arthroplastie trapézométacarpienne à double mobilité Moovis – résultats préliminaires à 1 an de recul d’une série prospective. Chirurgie de la Main. 2015. DOI: 10.1016/j.main.2015.10.074

[27] The Moovis® implant for trapeziometacarpal osteoarthritis: results after 2 to 6 years. Journal of Hand Surgery (European Volume). 2020. DOI: 10.1177/1753193420901435

[29] A Lange Medical Book Current Diagnosis Treatment In Orthopedics Fifth Edition. 9Hand Surgery > Image DISORDERS OF THE MUSCULATURE OF THE HAND.

[30] Exam Of The Hand Wrist 2Ed. 1.1 SKELETON OF THE HAND > The osseous skeleton.

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

[32] Exam Of The Hand Wrist 2Ed. Functional cutaneous units.

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

[37] Exam Of The Hand Wrist 2Ed. Techniques of investigation of the arterial supply by J P Melki > Vascularization of the thumb > Palmar aspect.

[40] A Lange Medical Book Current Diagnosis Treatment In Orthopedics Fifth Edition. 9Hand Surgery > FLEXOR TENDON INJURY.

[42] Exam Of The Hand Wrist 2Ed. The dorsal skin.

[43] Green S Operative Hand Surgery. PERTINENT ANATOMY.

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Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.


Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.