Between May 1999 and April 2002 a total of 69 consecutive thumb carpometacarpal joint arthoplasties were performed in a total of 64 patients for carpometacarpal joint osteoarthritis using the cementless hydroxyapatite (HA)-coated unconstrained ARPE implant. Clinical, functional and radiological results at 10-year follow-up are presented. Survival analysis was performed using the Kaplan–Meier method. Of the 64 patients, four were lost to follow-up, 60 implants (92.3%) were functional and five (7.7%) were not (two dislocated, two were removed and one with aseptic loosening). Survival estimate for functional implants over 10 years was 93.9% (95% confidence interval 82.3–97.9). The radiographs were satisfactory in 82.4%. There was subsidence of the cup in 15.8%. Thumb carpometacarpal joint arthroplasty with the ARPE implant offers a reliable treatment alternative in patients with Eaton grade III or IV thumb carpometacarpal joint arthritis in the presence of good bone stock.

Background and aims: Meal replacement diets consist of replacing one or more meals with an artificial nutritional supplement. The objective of this study was to compare the effect of one against two meal replacement strategies on body composition and cardiovascular risk parameters in patients with obesity. Methods: A randomized clinical trial was designed with a modified hypocaloric diet with an artificial nutritional preparation replacing one or two meals for three months in patients with obesity and osteoarthritis pending orthopedic surgery. An anthropometric evaluation and a measurement of the body composition were done with bioelectrical impedance measurement at the beginning and at three months. Results: A total of 112 patients were recruited. Fifty-two patients (46.4%) were randomized to one replacement and 60 patients (53.6%) to two meal replacements. Eighty-one patients (72.3%) were women, and the average age was 61 (11.03) years. The percentage of weight loss at three months was 8.27 (4.79)% (one meal replacement: 7.98 (5.97)%; two meal replacements: 8.50 (3.48)%; p = 0.56). A decrease in fat mass measured by the fat mass index (FMI) was detected (one meal replacement: −2.15 (1.45) kg/m² vs. two meal replacements: −2.78 (2.55) kg/m²; p > 0.05), and a relative increase in fat-free mass was observed (one meal replacement: +3.57 (4.61)% vs. two meal replacements: +2.14 (4.45)%; p > 0.05). A decrease in HOMA-IR, systolic blood pressure (SBP), and total cholesterol was observed in both groups without differences between them. Conclusions: The substitution strategies of one or two meal replacements were effective in weight loss and fat mass decrease without differences between the two groups. An improvement in lipid parameters, glycemic control, and systolic blood pressure was observed without differences between strategies.

Background: Trapeziometacarpal (TMC) osteoarthritis is the most prevalent osteoarthritis of the upper limb. It is one of the most disabling conditions. Currently, the most suitable surgical technique is debated. Trapeziectomy with ligamentoplasty continues to be the gold standard; however, results for function, esthetics, and quality of life have not been optimal. For this reason, surgeons have continued to refine and develop various surgical techniques, among which total arthroplasty is increasingly emerging as a major alternative, but it has not yet demonstrated superiority and its durability is still in doubt. Questions/purposes: At a minimum follow-up time of 5 years, do patients with total basilar thumb arthroplasty, compared with patients with trapeziectomy and ligament reconstruction, have (1) better pain as measured by a VAS scale, (2) lower disability as measured by the DASH, and (3) better tip pinch strength and functional range? Methods: This was a prospective study conducted in a specialized hand surgery unit within a tertiary-level referral hospital located in an urban area, with 54 patients diagnosed with TMC osteoarthritis administratively assigned to two different surgeons. Between February 2018 and June 2018, we treated 54 patients for TMC osteoarthritis. Of those, we considered as potentially eligible patients who met the following inclusion criteria: TMC osteoarthritis classified as Eaton-Littler Type III or IV, good bone quality, persistent pain lasting for > 6 months, and failure to respond to conservative treatment. The study was designed as a parallel group study in which patients treated by one surgeon were treated with total arthroplasty and patients treated by the other study surgeon were treated with trapeziectomy with ligamentoplasty. Patients were administratively assigned to their groups, and the surgeons were comparably experienced and performed similar surgical volumes. A total of 27 patients were treated with total arthroplasty, and 27 patients were treated with trapeziectomy with ligamentoplasty. One patient in the total arthroplasty group was lost to follow-up after the intervention for personal reasons unrelated to the study or the disorder. For this reason, that patient was excluded from the study. Finally, among the 26 patients who underwent arthroplasty at the end of the follow-up period, 96% (25) were women, and the mean ± SD age was 59 ± 8 years. Four percent (1) of patients were lost to follow-up before 5 years. Of the 27 patients who received ligament reconstruction and tendon interposition, 96% (26) were women with a mean ± SD age of 59 ± 7 years. A total of 0% (0) were lost to follow-up before 5 years. This left 96% (26) of patients in the total arthroplasty group and 100% (27) in the tendon interposition arthroplasty group, respectively. The mean ± SD follow-up time for all patients was 78 ± 4 months. The mean follow-up time for patients who received total arthroplasty was 78 ± 4 months, and it was 77 ± 3 months for those who received trapeziectomy with ligamentoplasty. The minimum follow-up period for inclusion was 5 years (60 months). Patients in the two treatment groups did not differ in terms of age, sex, dominant hand surgery, functional work requirement, concomitant disorder, radiographic characteristics, and Eaton-Littler stage, but a higher percentage of patients in the total arthroplasty group had carpal tunnel syndrome at the time of presentation (58% [15 of 26] versus 30% [8 of 27]; p = 0.04). Pain was assessed using a VAS ranging from 0 (pain free) to 10 (maximum pain), with a clinically significant change defined as 0.7 to 0.9. Functionality was evaluated using the DASH questionnaire, with a minimum clinically important difference (MCID) of 10.83. Secondary outcomes included mobility, measured through radial abduction and retropulsion of the thumb using a goniometer, and thumb opposition assessed by the Kapandji index, which scores opposition on a scale of 0 to 10. Grip strength was measured with a pinch gauge, averaging three measurements, with an MCID of 0.33 kg. Results: At 5 years, patients who had total arthroplasty had less pain compared to patients with trapeziectomy with ligament reconstruction (VAS 1.3 ± 0.7 versus 3.0 ± 0.9, mean difference 1.7 [95% confidence interval (CI) 1.3 to 2.1]; p < 0.001). Patients who had total arthroplasty had lower scores for upper extremity disability at 5 years (DASH 11 ± 9 versus 28 ± 12, mean difference -17 [95% CI -22 to -12]; p < 0.001). There was no clinically important difference between the groups in terms of tip pinch strength as measured in kg (3.7 ± 0.6 versus 3.2 ± 0.6, mean difference 0.4 [95% CI 0.1 to 0.8]; p = 0.01). Regarding mobility, we found differences between the total arthroplasty group and the trapeziectomy with ligamentoplasty group at 5 years of follow-up (Kapandji score 9.9 ± 0.4 versus 8.5 ± 0.6, mean difference 1.4 [95% CI 1.0 to 1.8]; p < 0.001). Conclusion: In light of these findings, surgeons should consider total arthroplasty as a first-line therapeutic option for patients with advanced TMC arthritis, especially those with significant pain and persistent functional limitations. While both treatments offer benefits, total arthroplasty provides superior pain relief and greater improvement in functional disability. Future studies should focus on the long-term durability of total arthroplasty compared to trapeziectomy with ligamentoplasty, with follow-up visits extending beyond 10 to 20 years to assess implant longevity and potential late complications. Level of Evidence Level II, therapeutic study.

Demand for total knee arthroplasty (TKA) in octogenarians will increase in subsequent years as society ages. We conducted a retrospective observational study in octogenarians operated on with TKA between 2015 and 2019, comparing preoperative and postoperative Knee Society Score (KSS), Knee Society Function Score (KSFS), extension and flexion balance, and radiologic alignment using a paired Student t-test. A chi-squared test was used to correlate mortality with Charlson comorbidities index score and with ASA scale. Kaplan–Meier analysis was performed to calculate patient survival. In this period 36 patients ≥80 years underwent TKA, with a mean age of 81.6 years. Of these, 24 patients (66.7%) were classified as ASA II and 12 (33.3%) as ASA III. Sixteen patients (44.4%) were Charlson 0, 14 (38.9%) Charlson 1, two (5.6%) Charlson 2, and four (11.1%) Charlson 3. KSS, KSFS, flexion and extension range, and radiologic alignment were statistically significant (p < 0.001) when comparing preoperatory and post-operatory data. No correlation (p > 0.05) was found between mortality and ASA or Charlson score. Seven patients (19.4%) suffered a medical complication and two patients experienced surgical complications. Four patient died (11.1%) during follow-up. The mean patient survival was 67.4 months. Patients ≥80 years achieve clinical improvement after TKA. Comorbidities, not age, are the burden for surgery in older patients.

Trapeziometacarpal osteoarthritis (TMCOA) is a highly prevalent disease in the older population. Many different types of surgical treatments are possible, depending on the degree of joint involvement, the personal and professional circumstances of the patient and the preferences of the orthopedic surgeon. This paper evaluated the clinical and radiological results of consecutive cohorts of patients over 65 years old treated with total joint arthroplasties (TJA) of the ball and socket type (B&S) for TMCOA, with a minimum of 10 years follow-up. The survival rate (Kaplan–Meier) of the functional prostheses at 10 years was 92.2% (95% CI (89.1%, 96.1%). These functional arthroplasty patients, after 10 years of follow-up, showed little or no pain, good function and good key pinch, without radiological alterations. TJAs of the B&S type are a long lasting, effective and reliable alternative to surgical treatment of TMCOA in patients over 65 years of age, when they are performed with the patient selection criteria and surgical technique described throughout this study.

Objective: To present the functional results obtained and the possible surgical difficulties after the surgical treatment of Dupuytren’s disease (DD) recurrence in patients previously treated with Clostridium histolyticum (CCH) collagenase. Materials and methods: In this prospective study, 178 patients with DD were treated with CCH from 2011 to 2018; During long-term postoperative follow-up, 34 patients (19.1%) had recurrence of DD. In all patients injected in the IFP the disease recurred; In patients injected in the MCP, recurrence was highest in grade III and IV of the Tubiana classification, with involvement of the 5th finger and the two-finger Y-chord. Fourteen patients (7,8%) required surgery by partial selective fasciectomy due to recurrence of cord DD infiltration. The clinical and functional results of the patients, the difficulty of the surgical technique and the anatomopathological analysis of the infiltrated cords were evaluated in comparison with those of cords and patients who had had no previous CCH treatment. Results: In all patients, cord rupture was achieved after injection, reducing joint contracture. In 14 patients, we observed during the follow-up the existence of DD recurrence that required surgical treatment by selective partial fasciectomy. There were no major difficulties in surgery and good clinical and functional results at 6 months of follow-up. The anatomopathological study of the resected tissue did not present histological alterations with respect to the samples obtained from patients initially treated by selective partial fasciectomy. Conclusions: Selective fasciectomy after CCH injection does not lead to important operative difficulties, as long as the CCH injection is performed according to the recommendations. There were no histological changes in the tissue after CCH injection. Level of evidence: III.