RESUMO
Long-term results of trapeziometacarpal (TMC) joint silicone arthroplasty were evaluated. From 1975 to 1990, 90 TMC joint silicone implants were placed in 85 patients with TMC joint arthritis caused by osteoarthritis and inflammatory arthritis. Sixty-two implants in 58 patients were available for follow-up evaluation averaging 16.4 years (range, 10-25 years) with a 10-year minimum. Patient satisfaction; range of motion; grip, key pinch, and tip pinch strengths; and radiographs were recorded. Eighty-four percent of the thumbs had satisfactory results with good-to-excellent pain relief and function. Grip, key pinch, and tip pinch strengths increased. The number of thumb tips able to touch the palmar base of the small finger increased. Subluxation was apparent in 19% of implants but was not clinically important; however, implant fracture occurred in 6% and required revision. None of the 62 implants had frank silicone synovitis. Silicone arthroplasty seems to be a reliable option for disabling TMC joint arthritis and is associated with a high degree of patient satisfaction.
Assuntos
Artroplastia de Substituição/métodos , Elastômeros de Silicone/farmacologia , Polegar/cirurgia , Articulação do Punho/cirurgia , Adulto , Idoso , Ossos do Carpo/diagnóstico por imagem , Ossos do Carpo/cirurgia , Feminino , Seguimentos , Força da Mão , Humanos , Prótese Articular , Masculino , Metacarpo/diagnóstico por imagem , Metacarpo/cirurgia , Pessoa de Meia-Idade , Osteoartrite/diagnóstico por imagem , Osteoartrite/cirurgia , Medição da Dor , Desenho de Prótese , Radiografia , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Estudos Retrospectivos , Estudos de Amostragem , Polegar/diagnóstico por imagem , Resultado do Tratamento , Articulação do Punho/diagnóstico por imagemRESUMO
The acute flare of joint inflammation in the child with known juvenile rheumatoid arthritis causes concern primarily regarding the need for additional or modified medical treatment. Acute joint inflammation in an otherwise healthy child creates concern regarding the existence of joint infection. In the early phase of disease, the clinical findings and symptoms of an inflamed joint attributable to juvenile rheumatoid arthritis or infection may be similar and difficult to differentiate from the other. Juvenile rheumatoid arthritis usually is well controlled by medical interventions, however, the initiation of specific treatment is more urgent in children with joint sepsis. The following case report is presented to emphasize the difficulty in evaluation of patients with known juvenile rheumatoid arthritis and coexistent septic arthritis, and to discuss the methods used to differentiate between the two conditions.