Small joints replacement for hand osteoarthritis: a systematic review

Area of Science:

• Orthopedic Surgery
• Hand Surgery
• Biomaterials Science

Background:

• Osteoarthritis of the hand, particularly in the trapeziometacarpal (TMC) and metacarpophalangeal (MCP) joints, is a common condition requiring effective treatment.
• Small joint replacement surgery is a viable option for managing moderate to severe hand osteoarthritis, with various implant designs and materials available.

Purpose of the Study:

• To review the current literature on small joint replacement in hand surgery.
• To evaluate the clinical and functional outcomes of different implant materials, specifically silicone and pyrolytic carbon.
• To identify areas of agreement and controversy regarding implant efficacy and complications.

Main Methods:

• A comprehensive online literature search was conducted using Medline, Cochrane, and Google Scholar databases.
• Studies focusing on small joint replacement in hand surgery were identified and reviewed.

Main Results:

• Both silicone and pyrolytic carbon implants demonstrate good functional and clinical outcomes for TMC and MCP joint replacements.
• Silicone spacers are particularly effective for TMC osteoarthritis, while pyrolytic carbon prostheses excel in MCP joint replacement.
• Complications such as persistent pain and implant loosening occur with variable frequency across studies.

Conclusions:

• High-quality, well-designed trials with larger patient cohorts are necessary to definitively compare different implants and techniques.
• Improved study methodologies are crucial for drawing clinically relevant conclusions and establishing clear treatment guidelines.
• Further research should focus on standardizing assessment methods to enable robust comparative analyses of hand joint prostheses.