The authors report their experience with the uncemented Swanson titanium implant for the treatment of basal joint arthritis. Nineteen Swanson implants were placed in 18 female patients (mean age 57 years) with advanced trapeziometacarpal osteoarthritis (Eaton and Littler grades 3 and 4). One joint dislocated 4 month post-operatively and was removed. The remaining 17 patients, 18 joints, were evaluated at a mean follow-up of 34 months. Good pain relief was noted in 13 cases. Radiographic loosening occurred with 5 implants and trapezial wear in 10 joints. These radiographic changes did not correlate with pain or impaired hand function.
Operative treatment of basal joint arthritis is indicated in symptomatic individuals when appropriate conservative treatment measures fail. Surgical alternatives include trapeziectomy with or without ligament reconstruction and tendon interposition, arthrodesis, osteotomy of the first metacarpal, and implant arthroplasty. In 1997, Swanson et al. reported their experience with 92 patients who underwent cementless titanium implant hemiarthroplasty for the treatment of arthritis affecting the thumb basal joint (CORR 342:46-58, 1997). Ninety-five percent of the patients in their series were satisfied at an average follow-up of 5 years. Caution has been advised in the use of this procedure in high-demand patients and in those with poor bone stock. Prosthetic loosening and trapezial wear may result in clinical failure with longer follow-up.
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J Hand Surg