Carpal bone titanium implant arthroplasty. 10 years' experience.

In 1984, in an effort to address the silicone wear particle problem, titanium implants were developed for the scaphoid, lunate, and trapeziometacarpal joint. The design of these implants closely resembled their silicone counterparts, though some modifications were made to accommodate the properties of unalloyed titanium and enhance their stability. Carpal bone implants act as articulating spacers to help maintain the relationship of adjacent carpal bones after local resection procedures.

Use of grommets for flexible implant resection arthroplasty of the metacarpophalangeal joint.

In 1987, after 11 years of research, press fit titanium circumferential grommets were introduced for arthroplasty of the metacarpophalangeal joint to protect the flexible hinge implant midsection from sharp bony edges and shearing forces that can initiate implant abrasions and tears leading to implant fracture and formation of silicone wear particles. The effectiveness of the titanium circumferential grommets was assessed by comparing the results of 170 metacarpophalangeal joint implant (high performance) arthroplasties performed with (139 joints) and without (31 joints) grommets in 38 patients presenting an average 5.8 years followup.

Use of grommets for flexible hinge implant arthroplasty of the great toe.

A double stemmed flexible hinge implant was designed in 1974 for use with the Mayo type resection arthroplasty of the first metatarsophalangeal joint. Press-fit titanium grommets were developed in 1985 to protect the implant midsection from sharp bony edges and shearing forces that can lead to implant abrasion or fracture, and particulate synovitis. The study of 90 first metatarsophalangeal joint implant arthroplasties performed with encircling press fit titanium grommets showed favorable bone response around the implant stems and the bone to grommet interface, with absence of complications relating to particulate reactivity, implant or grommet fracture.

Flexible implant resection arthroplasty of the proximal interphalangeal joint.

Flexible implant arthroplasty of the PIP joint in post-traumatic disorders can have very successful long-term results provided that the recommended surgical indications, operative techniques, and postoperative rehabilitation programs are carefully adhered to. Stability of the collateral ligament system and integrity of the extensor and flexor mechanism are essential prerequisites. A central slip splitting, central slip sparing, and palmar approach are described.

Implant resection arthroplasty in the treatment of Kienböck's disease.

The lunate implant acts as an articulating spacer to maintain the carpal bones relationship after a resection procedure. Its use helps preserve functional wrist mobility and stability. Our experience spans 25 years and the use of three materials.

Femoral head intramedullary stemmed implant. A historical prospective.

A historical review reveals that McBride may have been the first to use a femoral head intramedullary stemmed hip implant. It had a threaded stem and limited use. Eicher may have been the first to develop and use the smooth intramedullary stemmed femoral implant with a calcar collar, which was the forerunner of implants used today.

The use of a grommet bone liner for flexible hinge implant arthroplasty of the great toe.

Press-fit titanium grommets were developed to shield flexible hinged silicone implants used for arthroplasty of the radiocarpal, metacarpophalangeal, and metatarsophalangeal joints. Since 1985, 179 titanium circumferential grommets were used in 90 first metatarsophalangeal joints with excellent, pain-free, functional results and favorable bone response around the implant stems and at the bone-grommet interface. There were no complications due to particulate reactivity, implant fracture, or grommet fracture.

Constrained total elbow arthroplasty.

In 1972, the senior author designed a condylar-sparing constrained hinge elbow prosthesis with a high-density polyethylene bushing. The condylar-sparing design allows both intercondylar and intramedullary fixation of the humeral component with methylmethacrylate cement. Reattachment of the muscles and collateral ligaments to the preserved condyles provides further stability.

Bipolar implant shoulder arthroplasty. Long-term results.

The bipolar shoulder implant (BSI), designed by the senior author in 1975, has an unfixed metal glenoid cup with a polyethylene liner that articulates with a cemented titanium humeral component. The BSI was inserted in 35 shoulders of 33 patients with severe rheumatoid arthritis (20 cases), degenerative arthritis (ten cases), and posttraumatic lesions (five cases). The follow-up period ranged from 24 to 140 months (average, 63 months).

Evaluation and treatment of the upper extremity in the stroke patient.

Selected surgical procedures to correct specific deformities of the upper extremity in the stroke patient related to muscle imbalance, spasticity, contracture, and joint instability as seen in spastic hemiplegia are described. The postoperative rehabilitation is also discussed with regard to functional and anatomic disabilities, considering first the patient, then the extremity, and finally, the hand.

Evaluation of impairment in the upper extremity.

A system for evaluation of physical impairment in the hand and upper extremity was developed and has been tested and used by many hand surgeons around the world. It was approved for international application by the International Federation of Societies for Surgery of the Hand. A method for evaluating amputation and sensory and motion impairments has been devised for the hand and upper extremity.

Reconstruction of the thumb basal joints. Development and current status of implant techniques.

The problems presented at the thumb basal joints differ in osteoarthritis and rheumatoid arthritis. Therefore, the proper treatment must be selected from several options including resection of the trapeziometacarpal joint with or without a convex or concave condylar implant and resection arthroplasty of the trapezium with or without a trapezium implant. Proper medialization of any basal thumb implant and stability over the scaphoid facet are essential for a good result.

Bone remodeling phenomena in flexible implant arthroplasty in the metacarpophalangeal joints. Long-term study.

The durability of any implant procedure is related to the host bone tolerance. This can be evaluated in part by measuring the cortical bone thickness around the device. The purpose of this study is to evaluate the long-term bone response to silicone implants at the metacarpophalangeal joint level in a series of 133 digits with a minimum of five years of follow-up evaluation.

Bipolar implant shoulder arthroplasty.

A bipolar implant was designed by the author in 1975 for reconstruction of the severely arthritic shoulder. It has the advantage of not requiring glenoidal component fixation, but still provides an artificial joint interface. The ball of the humeral intramedullary stemmed component articulates with a polyethylene bearing within the glenoid cup component.

Scaphoid implant resection arthroplasty. Long-term results.

A silicone scaphoid implant was developed in 1967 to help improve the results of simple resection arthroplasty in the treatment of arthritic changes associated with advanced scaphoid disease. Patients who had scaphoid implant surgery since 1967 were studied. Preoperative and postoperative roentgenograms, charts, surgical pathology, and clinical evaluations were reviewed.

Osteoarthritis in the hand.

Patients who have disabling osteoarthritis of the hand are frequently given the wrong diagnosis, poor professional advice and inadequate treatment programmes. The exact cause of primary osteoarthritis remains unknown; however, an interplay of genetic factors, mechanical factors and biomechanical alterations in cartilage seems to be important. The incidence of primary osteoarthritis in the general population is very high.

Arthroplasty of the thumb basal joints.

Implant arthroplasty reconstruction of the thumb basal joints can provide pain-free, stable mobility and improved strength. The complications are few and essentially retrievable. The recommended operative procedures are challenging and must be carefully executed to obtain rewarding results.

Flexible implant resection arthroplasty for the rheumatoid hand and wrist.

Surgery of destroyed joints in the hand and wrist in the arthritic patient can be added to the armamentarium of the reconstructive arthritis surgeon. With proper patient selection, appropriate surgical technique, and postoperative management, rewarding results with freedom of pain and improved function can be expected.

Flexible implant arthroplasty in the rheumatoid metacarpophalangeal joint.

A brief review of the possible methods of reconstruction of the arthritic MP joint including synovectomy, arthrodesis and arthroplasty with or without implant has been presented. The surgical technique for flexible hinge implant arthroplasty at the MP joint of the fingers and thumb has been detailed. A computer analysis of the results of MP joint flexible implant arthroplasty obtained in a special field clinic study have been presented.

Flexible implant arthroplasty of the radiocarpal joint. Surgical technique and long-term study.

The wrist joint is frequently impaired in rheumatoid, post-traumatic, and degenerative arthritis. Stable radiocarpal motion, even limited, can improve functional hand adaptations, especially if the proximal or distal joints are disabled. A flexible silicone intramedullary stemmed hinged implant was developed in 1967 to be used as an adjunct to resection arthroplasty of the radiocarpal joint while at the same time maintaining the radiocarpal relation and allowing wrist motion in all planes.

Implant arthroplasty in the hand and wrist. An update.

The authors present a classification of the implant materials available, the basic types of implants, their fixation and the basic methods of implant arthroplasty used in the hand and wrist.

Implant arthroplasty for metacarpal and interphalangeal joints in rheumatoid arthritis.

An ongoing research project for the development of flexible implants for small joint arthroplasty in the extremities has been carried out since 1962 by the senior author, based on the concept that a low-modulus implant would not harm bone because of its force dampening characteristics. Implants made of medical grade silicone elastomer were designed, developed and extensively tested in laboratory and clinical studies. Long term clinical, radiographic and biological studies have shown these implants to have excellent biocompatibility and biodurability.