[GUEPAR total trapeziometacarpal prosthesis in the treatment of arthritis of the thumb. 36 case reports]. / La prothèse totale trapézo-métacarpienne GUEPAR dans le traitement de la rhizarthrose. A propos d'une série de trente-six cas.

ABSTRACT

The authors review a series of 36 total GUEPAR trapezometacarpal arthroplasties, performed between 1981 and 1990 in 32 patients, with a Dell stage III or IV carpometacarpal arthritis of the thumb (primary arthritis = 34 cases; secondary arthritis 2 cases, 1 case of chondrocalcinosis, 1 case of osteochondromatosis). Scaphotrapezial arthritis present in 7 cases is not a contraindication to total arthroplasty. The mean follow-up period was 3 and a half years, with a range of 1 to 9 years. Functional results were considered to be good in 89%, without limitation of activity. X-ray study shows 1) A radioclinical concordence in 64% of cases with good clinical and X-ray results, stable in the long term. 2) A radioclinical discordance in 22% of cases with good functional result but mobilisation of metacarpal stem. 3) Failure in 5 cases (14%) with unsealing and trapezial fracture. This radioclinical study yields two failure factors preoperative destruction of trapezium in all the failures and these cases are now a contraindication to the prosthesis and inadaptation between stem arthroplasty and metacarpal cavity. This study supports total arthroplasty in trapezometacarpal arthritis of the thumb III or IV Dell's stage, with preserved trapezium configuration.