Effective shape of ball-and-socket prosthesis in restoring range of thumb motion for total thumb carpometacarpal joint arthroplasty: three-dimensional motion analysis.

PURPOSE: Total joint arthroplasty (TJA) has often been used to treat thumb carpometacarpal (CMC) osteoarthritis (OA). However, guidelines for the CMC prosthesis shape remain unclear. This study aimed to identify the effective shape of a ball-and-socket prosthesis in restoring the range of thumb motion after TJA. METHODS: The participants were 10 healthy young adult men (22-32 years; 26.8 ± 3.57 [mean ± SD]). CT scans were performed in eight static limb positions during abduction and flexion. We defined three design variables (offset R, height H, and neck rotation angle Φ) as the variables that determine the basic shape of the ball-and-socket prosthesis. The ideal values of these design variables were examined based on the results of a 3D motion analysis, which evaluated the change in the posture of the first metacarpal (r, h, and φ corresponding to R, H, and Φ, respectively) relative to the center of rotation (COR) during abduction and flexion. We also simulated the effect of these design variables on the range of thumb motion after TJA using 3D CAD. RESULTS: We found that the values of r and h averaged over all limb positions were 6.92 ± 1.60 mm and 51.02 ± 1.67 mm, respectively, showing that these values remained constant regardless of limb position. In contrast, φ changed significantly. The simulation results indicated that Φ affected the range of thumb motion after TJA, and Φ = 0° relatively reproduced all limb positions compared to other values. CONCLUSION: Our results suggested that the desirable values of R and H were the average of r and h over several limb positions and that Φ = 0° was effective in restoring the range of thumb motion after TJA. Our results will provide surgeons with new guidelines for selecting a prosthesis.

Optimal Center of Rotation for Ball-And-Socket Thumb Carpometacarpal Arthroplasty Identified Using Three-Dimensional Kinematic Analysis: A Pilot Study.

Total joint arthroplasty is one of the surgical option for thumb carpometacarpal (CMC) joint arthritis, however the optimal position the center of rotation (COR) has not been quantified. The purpose of this study is to identify ideal ball-and-socket thumb carpometacarpal joint implants and the optimal position of the COR. We obtained eight right thumb computed tomography images each from ten healthy men, comprising four images each of thumbs at various angles of flexion-extension and abduction-adduction. We reconstructed 3D bone models on 3D CAD, created virtual ball-and-socket implants with three variables (neck offset, implant height, neck rotation), and found the optimal COR where the position change in the COR was smallest across various thumb positions. When the offset was 4.5 mm, neck rotation angle was 130.6° from the radial side to the palmar side of the first metacarpal, and implant height from the distal end of the metacarpal was 43.6 mm, we could restore almost normal kinematics. This study could serve as a reference for implant development and surgical technique guidelines.

In Vivo Kinematics of the Thumb Carpometacarpal Joint During Flexion and Abduction.

Background: Despite the movement of the thumb carpometacarpal joint has been studied, many unclarified points remain regarding the movement of this joint. The purpose of this study was to evaluate the in vivo kinematics of the thumb carpometacarpal joint during flexion and abduction using computed tomography images. Methods: The subjects were 9 healthy males. Computed tomography images were obtained in 4 equally-divided positions from maximum extension to maximum flexion, and maximum adduction to maximum abduction of the thumb. A three-dimensional model was constructed from these images, and the models of each position were superimposed with reference to the trapezium. The amount of angular change around the bone axes of first metacarpal bone and rotation axes were evaluated. Results: We found that the first metacarpal bone showed relatively simple behavior during abduction. However, during flexion, it exhibited a particular movement in which the amount of angular change of the metacarpal bone with respect to the trapezium rapidly increased with deep flexion. Conclusions: These results suggest that the thumb carpometacarpal joint exhibits a special movement during flexion, especially deep flexion.