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Complications of the Artelon Spacer in CMC Arthroplasty

Brian Gander, Ronit Wollstein
University of Pittsburgh Medical Center
2012-01-27

Presenter: Brian H, Gander

Affidavit:

Director Name: Joseph Losee, MD

Author Category: Other Specialty Resident
Presentation Category: Clinical
Abstract Category: Hand

How does this presentation meet the established conference educational objectives?
By discussing potential complications and their rate of occurance of a treatment modalitiy.

How will your presentation be used by practicing physicians in the audience?
By furthering the informed consent procress with regards to the Artelon Spacer and potential complications.

Hypothesis:
The Artelon Spacer was developed for the use in thumb carpometacarpal (CMC)joint arthritis to both resurface the distal trapezium and stabilizing the trapeziometacarpal joint. Reported complications are osteolysis, inflammatory reactions and revision surgery secondary to persistent pain. We hypothesize complications may be related to Arthritis grade and surgical technique.

Methods:
We reviewed our short-term outcomes analyzing pre and postoperative radiographic measures, operative technique, complications and subsequent surgeries.

Results:
In 30 months 29 patients average age 51 (34-66) years underwent Artelon spacer placement. Sixteen patients were male, 13 were female. Average follow-up was 8 (1-26) months.
Postoperative complications were noted in 12 patients with 9 displaying radiographic osteolysis and 4 requiring conversion to CMC suspensionplasty due to persistent pain. The rate of radiographic osteolysis or revision surgery was not significantly associated with preoperative Arthritis grade, spacer fixation method, spacer modifications or instruments used performing osteotomies. More frequent osteolysis was noted when preoperative metacarpal subluxation was present and when osteotomy of the trapezium was performed without osteotomy of the metacarpal (Fisher exact one-sided p=0.106, p=0.081, respectively).

Summary:
Our study found a significant short-term complication rate following Artelon spacer arthroplasty in the CMC joint. We could not identify any factors associated with the revision rate. However, there was a trend towards postoperative osteolysis when preoperative metacarpal subluxation was present and osteotomy of the trapezium was performed without osteotomy of the metacarpal.

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