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Loosening of the trapezial component is a main cause of failure of trapeziometacarpal prostheses. This report presents the preliminary results of scaphometacarpal prostheses used for revision of trapeziometacarpal prostheses and failed trapeziectomies. A retrospective multicentre study was conducted on ten patients. Four had revision surgery after failure of trapeziometacarpal prostheses, five after trapeziectomy and one after a trapezial silicone implant. Pain, mobility, strength, QuickDASH, satisfaction score and radiographs were assessed. Nine patients were assessed (one was lost to follow-up), with a mean follow-up of 34 months. The mean pain score was 1.2/10, Quick-DASH was 39 and opposition according to the Kapandji score was 8.6. Strength was 3 kg for key pinch and 13.6 kg for power grip. One failure was observed, with early loosening of the scaphoid cup. Scaphometacarpal arthroplasty is a reliable medium-term solution for revision of the loosening of a trapeziometacarpal prosthesis with trapezial damage and for failed trapeziectomy. Level of evidence: IV

Introduction: Repeated transfers and wheelchair propulsion in patients with a neurological deficit of the lower limbs overloads the upper limbs mechanically, particularly the shoulders, which become weight-bearing. Under these conditions, arthroplasty implants are subjected to large stresses, even though this indication is controversial in such a context. We hypothesized that joint replacement in weight-bearing shoulders will relieve pain and improve range of motion, with a positive impact on function and autonomy, without increasing the complication rate relative to the able-bodied population. Materials and Methods: This retrospective study involved 13 implants in 11 patients (4 total shoulder arthroplasty, 4 hemi-arthroplasty and 3 reverse shoulder arthroplasty) who had a mean follow-up of 33.7 ± 27 months (12-85 months). The clinical assessment included active and passive range of motion, pain, Constant score, and the Wheelchair User’s Shoulder Pain Index (WUSPI). Radiographs were evaluated to look for signs of loosening and scapular notching. The patients’ autonomy was evaluated through the number of transfers, means of locomotion (manual or electric wheelchair) and the functional independence measure (FIM). Two subgroups were defined based on the initial pathology: neurological shoulder or functional shoulder. Results: The 11 patients had a mean age of 64 ± 19 years (23-85 years) and were all long-term wheelchair users (electrical or mechanical). The pain level on VAS decreased from 8 ± 3 preoperatively to 4 ± 2 postoperatively (p = 0.003). The mean Constant score increased 90% from 22 ± 11 preoperatively to 42 ± 23 postoperatively (p = 0.008). The WUSPI score decreased by 73% from 80 ± 30 to 21 ± 15 (p = 0.001). The range of motion improved in the subgroup of patients with functional shoulders but not in the subgroup of patients with neurological shoulders. The means of locomotion was altered in five patients (63%) by the acquisition of an electric wheelchair, but with no significant change in the number of daily transfers. There were no radiographic signs of implant loosening at the final assessment. Two implants had to be revised: one anatomical prosthesis was converted to a reverse configuration because of a secondary rotator cuff rupture; one case of early infection required a two-stage implant change. Discussion: Joint replacement in weight-bearing shoulders is an effective medium-term solution for cuff tear arthropathy and glenohumeral OA, mainly for addressing pain, with slight improvements in range of motion, depending on the initial pathology. This intervention requires lifestyle adaptations such as changes in daily transfer practices and means of locomotion. Level of evidence: IV, retrospective study.

International audience; Thumb metacarpophalangeal instability is commonly found in conjunction with trapeziometacarpal osteoarthritis. If not corrected, it can have detrimental effects on the outcome. The authors describe the two types of metacarpophalangeal deformities - hyperextension and valgus - their pathophysiology and the surgical repair techniques available to surgeons. An algorithm for treating this instability is presented.

Shoulder pain associated with tendinopathy of the long head of biceps (LHB) is common. Surgical treatment with arthroscopic tenotomy of the LHB has been shown to be effective. However, it's efficacy is inconsistent. The objective of this study was to assess the pre-operative clinical and radiological prognostic factors of arthroscopic tenotomy of the long head of biceps, and to establish a predictive score for good responses to treatment; the IBTIS score (Isolated Biceps Tenotomy Index Score).Prognostic factors representing a good response to treatment of LHB tendinopathy by arthroscopic tenotomy exist.We conducted a retrospective monocentric study including 64 patients who underwent surgery of the LHB by arthroscopic tenotomy (with or without tenodesis) between January 2018 and March 2020. We identified 2 patient groups (good responder group and poor responder group) from a 3-month post-operative clinical assessment, which included a subjective assessment comprising Single Shoulder Value (SSV), Constant score, C-Test, and pain level. Prognostic factors of a good response were then sought from the 2 groups using interviews, clinical examinations and pre-operative imaging. Based on these findings, a predictive score for a good response was established.All evaluation criteria demonstrated post-operative improvement: mean SSV (72.2 vs 50.7; p0.001), relative constant (78.2 vs 64.3; p0.001), pain level (3.2 vs 7; p0.001) and C-Test (94.1 vs 85.6; p=0.07). 34 patients (58.6%) were considered good responders, while 24 patients (41.38%) were considered poor responders. There was a trend towards a favourable result for: age65 years (p=0.01), rotator cuff rupture on preoperative imaging (p=0.01), Cross Arm Test (p=0.02), nocturnal pain (p=0.08), Yergason's test (p=0.16) and Speed's Test (p=0.22). Manual labour appeared to be an unfavourable factor (p=0.07). These factors were incorporated into the 10-point IBTIS score. A score greater than 5 was associated with a favourable result in more than 80% of patients (p0.001).Our score consists of 7 items. We identified 7 pre-operative prognostic factors for a good result after LHB tenotomy. Over 65 years of age was found to be statistically significant in univariate analysis, as was visualization of rotator cuff rupture on pre-operative imaging. The Cross Arm Test was included given its high statistical significance. The Speed's Test and Yergason's Test are ubiquitous in the literature. Nocturnal pain was found in more than 80% of patients. Undertaking manual labour represented an unfavourable prognostic factor after arthroscopic surgery of the LHB.The IBTIS score (Isolated Biceps Tenotomy Index Score) is a pre-operative clinico-radiological score for the surgical treatment of arthroscopic tenotomy of the long head of biceps. Further studies are required to validate its prognostic accuracy.III; case-control.

Objectives: Shoulder pain related to long head of biceps tendinopathy is common. Surgical treatment by arthroscopic tenotomy has proven to be effective. The objective was to evaluate the preoperative clinical and radiological prognostic factors of arthroscopic tenotomy of the long head of biceps, and to establish a predictive score of good response to treatment. Methods: We conducted a retrospective single-center study including 64 patients who underwent surgery between January 2018 and March 2020 by arthroscopic LHB tenotomy, whether or not associated with tenodesis. We identified 2 groups of patients based on a clinical evaluation 3 months postoperatively, which included subjective assessment by the Single Shoulder Value (SSV), Constant, C-Test, and pain scores: a good responder group and a poor responder group. Prognostic factors for good response were then identified in the 2 groups based on questioning, clinical examination and preoperative imaging. Based on these factors, a predictive score for a good response was established. Results: All evaluation criteria showed postoperative improvement: Mean SSV (72.2 vs 50.7; p 65 years (p = 0.01), cuff tear on preoperative imaging (p = 0.01), the Cross Arm Test (p = 0.02), night-time pain (p = 0.08), Yergason’s test (p = 0.16), the Speed Test (p = 0.22). Manual labor appeared to be a factor in an unfavorable outcome (p = 0.07). These factors were incorporated into the 10-point IBTIS score. A score above 5 was associated with a favorable outcome in more than 80% of the patients (p Conclusion: The IBTIS (Isolated Biceps Tenotomy Index Score) is a preoperative clinical and radiological score with 7 items for surgical treatment by arthroscopic tenotomy of the long head of biceps. Further studies are required to validate the prognostic accuracy.

Thumb carpometacarpal osteoarthritis affects many post-menopausal women. If medical treatment fails, the most common options are trapeziectomy and trapezio-metacarpal arthroplasty. The purpose of this study was to evaluate the survival rate of trapezio-metacarpal prostheses in surgical treatment of thumb carpometacarpal osteoarthritis, and to highlight potential risk factors of unfavorable outcome. We performed a retrospective study involving 294 trapezio-metacarpal prostheses in 245 patients, who underwent surgery between 2001 and 2016. Clinical assessment was performed by self-questionnaire including pain, satisfaction, recovery time, QuickDASH Score, and opposition according to Kapandji score. Thumb X-rays were used to evaluate implant loosening sign, periprosthetic remodeling, and arthrosis of over and underlying joints. Implants survival rate at the final follow-up of 17.3 years was 90.8 % (95 % CI [85.8–96.1]). Median pain was 1 on 10 on VAS scale (0–8). Median QuickDASH Score was 20 (0–82), median opposition according to Kapandji was 9 on 10 (3–10). Median return to work time was 2 months (1–12). We identified 7.8 % of major complications, including 3.4 % of dislocations, 3.1 % of implants loosening, and 1 % of fractures. All dislocations involved surgical revision. Only few publications show results with more than 100 trapezio-metacarpal prostheses. Our results are consistent with existing studies. Trapeziectomy represents currently the gold standard in surgical treatment of thumb carpometacarpal osteoarthritis. Long-term superiority has not been proven in recent meta-analysis. Two recent studies found superiority of arthroplasty at short term concerning pain, strength, mobility, satisfaction, and recovery time, with similar complication rates. Trapezio-metacarpal arthroplasty is a long-term reliable solution for surgical treatment of thumb carpometacarpal osteoarthritis, with a limited complication rate.

Trapezio-metacarpal (TM) prosthesis has show good results in the surgical treatment of rhizarthrosis. One of the main causes of failure is tapezium loosening. For the revision of a failed prosthesis, trapeziectomy can be a solution. Another possibility is to implant a cup into the distal extremity of the scaphoid, thus performing a scapho-metacarpal arthroplasty. This scapho-metacarpal arthroplasty can also be used in the event of failed trapeziectomies. The purpose of this study is to present preliminary results of 10 cases of scapho-metacarpal prosthesis. A retrospective multicentric study was carried out on 10 patients, 9 women and 1 man, with an average age of 74 years, who underwent surgery between 2009 and 2015. Four had revision surgery after trapezio-metacarpal arthroplasty, 5 after trapziectomy, one hade a revision of silicon implant. The prosthesis that has been used was MAIA ® Prosthesis, with long or extra-long neck. Assessment covered – Visual Analog Pain Scale, mobility, strength, Quick-DASH, satisfaction score, preoperative, postoperative and the most recent X-rays (Kapandji incidences). Results Nine patients were assessed with a mean follow-up of 34 months, 1 patient was lost during the follow-up. Out of these 9 patients, we had 1 who failed, due to an early scaphoid cup loosening. There are 4 out of 9 patients who underwent surgery on their dominant hand. Four patient said they were very satisfied with the outcome, 4 were satisfied and 1 was not very satisfied. The average pain score was 1.2/10 and the average Quick-DASH was 38.5. The mean mobility of the carpometacarpal joint was – 48° in abduction, 40° in antepulsion, opposition according to Kapandji was 8.6, retropulsion was 1.9. Tumb strength measurements were 3 kg for key pinch, and 13.6 kg for grip strength. Radiographic assessment showed only one scaphoid cup loosening, and measurement of the length of the thumb column showed a shortening of 0.2 cm after surgery. Other surgical procedures has shown good results for revision of failed prosthesis such as secondary trapeziectomy, but only with short follow-up. Surgical procedures for failed trapeziectomy are very limited. Scapho-metacarpal arthroplasty is a reliable medium-term solution for revision of the loosening of a trapezio-metacarpal prosthesis with trapezium damage, as well as for failed trapeziectomy.

Introduction Une atteinte neurologique severe des membres inferieurs conduit a une surcharge fonctionnelle majeure des membres superieurs et notamment des epaules, par utilisation chronique de fauteuils roulants, de cannes et transferts repetes. Une arthroplastie sur ces epaules dites locomotrices, pour arthrose primitive ou secondaire a une rupture de coiffe, est souvent envisagee avec reticence du fait des contraintes mises en jeu. L’objectif de cette etude etait d’evaluer les resultats a moyen terme des arthroplasties sur epaules locomotrices, sur le plan analytique et en termes de restitution de l’autonomie anterieure. Materiel et methodes Nous rapportons une etude retrospective de 11 protheses chez 9 patients, 8 femmes et 1 homme, d’âge moyen de 68 ans (30–86), operees entre 2010 et 2016. Tous etaient utilisateurs d’un fauteuil roulant au long cours. Sur le plan neurologique, il s’agissait de 3 paraplegies, 2 tetraplegies, 2 poliomyelites, une sclerose en plaques et une arthrite chronique juvenile. Une patiente a ete exclue pour degradation cognitive. La revision portait sur 10 implants avec un recul moyen de 36 mois (7–85). L’evaluation clinique comprenait les mobilites, la douleur, les scores de Constant, American shoulder and elbow Surgeons score (ASES), Weelchair User Shoulder Pain Index (WUSPI) et un score de satisfaction. L’evaluation radiologique recherchait de signes de descellement ou d’encoche scapulaire. L’autonomie des patients etait evaluee par le nombre de transferts quotidiens et le mode de deplacement (cannes, fauteuil manuel ou electrique) Resultats Une prothese a ete reprise pour rupture secondaire de coiffe, on ne notait pas de descellement, ni de sepsis. L’evaluation analytique retrouvait une diminution de l’EVA de 8 (5–10) en preoperatoire a 4(1–6) en postoperatoire, avec augmentation globale des mobilites. Les scores moyens de constant, WUSPI, ASES, etaient respectivement de 19 (10–28), 82 (72–98), et 29 (12–42) en preoperatoire, contre 47 (36–58), 28 (15–42), et 78 (62–84) en postoperatoire. On retrouvait une baisse d’autonomie, avec diminution du nombre moyen de transfert journaliers, de 8 a 5 en moyenne, et necessite de changement du mode de deplacement, avec acquisition d’un fauteuil electrique pour tous les patients en postoperatoire. Discussion Cette intervention constitue un veritable tournant dans la vie des patients a mobilites reduite. La restitution d’une autonomie anterieure est delicate et la plupart des patients sont obliges de reduire leur nombre de transfert, et de changer leur mode de deplacement, afin de proteger leur arthroplastie. Conclusion L’arthroplastie prothetique sur epaule locomotrice represente une solution efficace en termes de douleurs et de mobilites, mais ne permet pas une restitution totale de l’autonomie anterieure.

Les fractures articulaires du radius distal peuvent s’accompagner de refends dans la fossette lunarienne conduisant a la separation de fragments anteromedial et posteromedial. Si l’osteosynthese par plaque anterieure verrouillee a fait la preuve de son efficacite dans les fractures du radius distal avec fragment anteromedial, la synthese specifique du fragment posteromedial (FPM), et les consequences d’une reduction insuffisante ont ete peu evaluees. L’objectif etait d’evaluer du point de vue tomodensitometrique la qualite de la reduction et de la fixation des fractures articulaires du radius distal avec FPM osteosynthesees par plaque anterieure verrouillee et leur correlation clinique. Dans une etude monocentrique retrospective, les criteres d’inclusion etaient : fracture articulaire du radius distal avec FPM confirme par scanner preoperatoire, osteosynthese par plaque anterieure verrouillee, sans ablation du materiel. La tenue du FPM par les vis de la plaque et la reduction du fragment par mesure des marches d’escalier articulaires etaient evaluees sur scanner apres consolidation. Les patients etaient separes en 4 groupes : FPM fixe et reduit, fixe et non reduit, non fixe reduit, non fixe non reduit. L’evaluation clinique au dernier recul comportait : mesures des amplitudes articulaires, de la force, de la douleur, scores fonctionnels Quick-DASH et Mayo Wrist. Une arthrose post-traumatique etait recherchee sur scanner. Dix patients repondaient a tous les criteres d’inclusion, avec un recul moyen de 18 mois (5–41). Les amplitudes articulaires dans les groupes de patients avec FPM reduit (fixe ou non), etaient superieures a celles des groupes avec FPM non reduit (90 % versus 61 % des amplitudes controlaterales, non significatif). Les scores fonctionnels etaient meilleurs en cas de fragment reduit : score de Quick DASH de 17,3 dans les groupes fragment reduit versus 52,5 (p = 0,083), score de Mayo-Wrist de 85,0 versus 41,7 (p = 0,080). Les FPM reduits et fixes sont caracterises par des vis prenant le fragment et atteignant la corticale posterieure. Des signes d’arthrose n’etaient presents que dans les groupes FPM non reduit, au niveau radiocarpien (p = 0,01), et radio-ulnaire distal (p = 0,32). Apres reduction, la tenue du FPM necessite une vis specifique atteignant sa corticale posterieure. Ce type de fracture necessite une planification par scanner preoperatoire et une analyse precise peroperatoire. L’existence d’un FPM necessite une osteosynthese specifique au risque d’evolution vers une arthrose radiocarpienne et radio-ulnaire distale.