Revision of trapeziometacarpal arthroplasty.

Complications of trapeziometacarpal arthroplasty are uncommon, but are classified as intra- and post-operative, dislocation and loosening being the main causes of revision surgery. Periprosthetic fracture and ossification are rare. Whenever possible, prosthetic revision techniques consist in partial or total replacement with modular implants.

MAÏA Trapeziometacarpal Joint Arthroplasty: Clinical and Radiological Outcomes of 76 Patients With More Than 10 Years of Follow-Up.

Purpose: Trapeziometacarpal (TMC) joint replacement has become a valid option in the therapeutic arsenal of TMC joint osteoarthritis in Europe. Good mid-term results of the MAÏA TMC joint prosthesis suggested that it is a reliable procedure. This study aimed to assess the long-term results of this modular uncemented ball-and-socket hydroxyapatite-coated implant.

Metacarpophalangeal hyperextension in trapeziometacarpal osteoarthritis: Relationship to first metacarpal head shape, and clinical impact.

Purpose: The aim of this study was to determine whether the shape of the first metacarpal head influences metacarpophalangeal hyperextension, and to evaluate the influence of metacarpophalangeal hyperextension on hand pain and function in patients with trapeziometacarpal osteoarthritis.

Methods: 362 patients with painful basal thumb osteoarthritis were evaluated over a 2-year period. Pain rating on a visual analog scale, trapeziometacarpal and metacarpophalangeal motion, and grip and pinch strength were evaluated.

Stemless shoulder arthroplasty.

The concept of stemless shoulder arthroplasty was born in 2005. It is now a valid option in the context of either anatomical or reverse shoulder replacement. Several questions have come up over our 15 years of using this system: How was the stemless shoulder arthroplasty concept born? It was motivated by a desire to have epiphyso-metaphyseal fixation using a corolla-shaped impacted anchor design.

Arthroscopic Latarjet procedure and suture-button fixation: can we predict nonunion early?

Background: The arthroscopic Latarjet procedure is a technically challenging technique that provides well-known results. The first series reported fixation with screws. An alternative fixation technique has been proposed, using a button, to improve the reproducibility and to decrease the complications due to screws.

Activating effective functional hand movements in individuals with complete tetraplegia through neural stimulation.

Individuals with complete cervical spinal cord injury suffer from a permanent paralysis of upper limbs which prevents them from achieving most of the activities of daily living. We developed a neuroprosthetic solution to restore hand motor function. Electrical stimulation of the radial and median nerves by means of two epineural electrodes enabled functional movements of paralyzed hands.

Restoration of elbow extension and construction of a "key grip" in people with tetraplegia. Comparative study of a surgical plan in one or two stages.

Aim: We report the comparative results of functional upper extremity surgery plans in patients with tetraplegia, including restoration of elbow extension and construction of a key grip in a "one-stage" or "two-stage" operation.

Materials And Methods: A series of 36 patients with tetraplegia, with a total of 45 operated upper limbs, was analyzed retrospectively with a mean follow-up of 23 months (13-39 months). We evaluated the analytical strength of elbow extension using the MRC (Medical Research Council) score, the strength of the key grip (kg/F) as well as the autonomy of the patients using functional scores; Lamb (/100) and QIF (Quadriplegia Index of Function) (/100).

Restoring Hand Functions in People with Tetraplegia through Multi-Contact, Fascicular, and Auto-Pilot Stimulation: A Proof-of-Concept Demonstration.

Two multi-contact epineural electrodes were placed around radial and median nerves of two subjects with high tetraplegia C4, American Spinal Injury Association Impairment Scale (AIS) A, group 0 of the International Classification for Surgery of the Hand in Tetraplegia. The purpose was to study the safety and capability of these electrodes to generate synergistic motor activation and functional movements and to test control interfaces that allow subjects to trigger pre-programmed stimulation sequences. The device consists of a pair of neural cuff electrodes and percutaneous cables with two extracorporeal connection cables inserted during a surgical procedure and maintained for 28 days.

Weight-bearing shoulder and rotator cuff tear.

Two percent of the general population are wheelchair-dependent. The shoulder takes on the weight-bearing locomotor function, and tends with age to develop degenerative pathologies, notably in the rotator cuff. The association between weight-bearing shoulder and rotator cuff tear raises several questions: what are the mechanisms by which wheelchair propulsion and transfer overload the shoulder, and what specificities do the lesions display? They occur in younger patients than in the rest of the population, after about 15 years' fairly constant wheelchair use.

Arthroplasty for weight-bearing shoulders.

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.

Selective neural electrical stimulation restores hand and forearm movements in individuals with complete tetraplegia.

Background: We hypothesized that a selective neural electrical stimulation of radial and median nerves enables the activation of functional movements in the paralyzed hand of individuals with tetraplegia. Compared to previous approaches for which up to 12 muscles were targeted through individual muscular stimulations, we focused on minimizing the number of implanted electrodes however providing almost all the needed and useful hand movements for subjects with complete tetraplegia.

Methods: We performed acute experiments during scheduled surgeries of the upper limb with eligible subjects.

Responsiveness of the Motor Capacities Scale to upper limb reconstructive surgery in persons with tetraplegia due to cervical spinal cord injury.

Study Design: Psychometric Study.

Objectives: To assess responsiveness of the Motor Capacities Scale (MCS) in people with tetraplegia who have undergone upper limb reconstructive surgery.

Settings: Rehabilitation clinics in France.

Scaphometacarpal arthroplasty: a report of ten cases of trapeziometacarpal prosthesis and trapeziectomy revision.

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.

Arthrodesis Versus Carpometacarpal Preservation in Key-Grip Procedures in Tetraplegic Patients: A Comparative Study of 40 Cases.

Purpose: Constructing a lateral key pinch (KP) is a universal aim of any functional upper limb surgery program for tetraplegia. Three stages are required: (1) activating the pinch mechanism by flexor pollicis longus tenodesis to the radius or by tendon transfer to the flexor pollicis longus, (2) simplifying the polyarticular chain, and (3) positioning the thumb column. We compared 2 techniques for accomplishing the latter stage, 1 utilizing arthrodesis of the carpometacarpal joint (CMC) and 1 that did not require arthrodesis of the CMC.

MAÏA Trapeziometacarpal Joint Arthroplasty: Clinical and Radiological Outcomes of 80 Patients With More than 6 Years of Follow-Up.

Purpose: Trapeziometacarpal (TMC) total joint replacement is increasingly being performed in Europe. MAÏA TMC total joint arthroplasty is a modular uncemented ball-and-socket hydroxyapatite-coated implant. This study assessed the midterm clinical and radiological results of the MAÏA TMC prosthesis.

Exploring Selective Neural Electrical Stimulation for Upper Limb Function Restoration.

This article introduces a new approach of selective neural electrical stimulation of the upper limb nerves. Median and radial nerves of individuals with tetraplegia are stimulated via a multipolar cuff electrode to elicit movements of wrist and hand in acute conditions during a surgical intervention. Various configurations corresponding to various combinations of a 12-poles cuff electrode contacts are tested.

Stemless shoulder prosthesis for treatment of proximal humeral malunion does not require tuberosity osteotomy.

Purpose: When the proximal humeral anatomy is altered because of malunion, shoulder arthroplasty is a challenge for the orthopaedic surgeon, and tuberosity osteotomy should be avoided whenever possible. The purpose of this study was to investigate the clinical and radiological outcomes of anatomic stemless shoulder arthroplasty in cases of malunion. We hypothesized that a stemless prosthesis can be implanted without performing tuberosity osteotomy.

Anterior glenohumeral joint stabilization in tetraplegic patients by medializing the anterior head of deltoid muscle.

To improve control of the upper limb in high-level tetraplegic patients, the proximal shoulder must be the first consideration. Medialization of the anterior part of the deltoid muscle provides stabilization and is then an antagonist to the posterior deltoid when a pectoralis major palsy exists. It can also be performed in isolation in high-level tetraplegia even when there is little hope of distal extremity reconstruction to stabilize the shoulder.

The TESS reverse shoulder arthroplasty without a stem in the treatment of cuff-deficient shoulder conditions: clinical and radiographic results.

Background: Reverse total shoulder arthroplasty (RSA) is a recent concept that enables good functional outcomes in cases of massive rotator cuff tear and cuff tear arthropathy. Design parameters influence the functional results and complications. The purpose of this study is to present the results of a novel RSA, the Total Evolutive Shoulder System (TESS; Biomet, Warsaw, IN, USA), based on a reverse corolla without a stem.

Rotator cuff surgery in persons with spinal cord injury: relevance of a multidisciplinary approach.

Background: This article is a prospective review of patients with spinal cord injury who underwent multidisciplinary consultation from January 2005 to September 2013 for pain in one or both shoulders.

Methods: We performed clinical, functional, and lesion evaluations of 38 patients with paraplegia and quadriplegia presenting with rotator cuff pathologies.

Results: Surgery was indicated and performed on 38 shoulders in 28 patients.

Results of a new stemless shoulder prosthesis: radiologic proof of maintained fixation and stability after a minimum of three years' follow-up.

Hypothesis: In total shoulder arthroplasty, the humeral component, particularly the stem, can be involved in some of the complications and technical difficulties increase in posttraumatic arthritis with proximal humeral malunion. To decrease the intraoperative complications related to the stem, the TESS (Biomet Inc, Warsaw, IN) humeral implant, was designed in 2004 hypothesis that we can obtain a good fixation with a stemless prosthesis. This investigation reports the preliminary results of this prosthesis with more than 3 years of follow-up.

Strategy for improving hand opening in the tetraplegic upper limb.

In the tetraplegic patient, restoring an adequate grip requires primary restoration of proper hand opening. This opening (or "extensor") surgical stage is performed 3 or 4 months before the closing (or "flexor") stage. Surgical strategy is based on group 5 of the IC, which represents a turning point.