Introduction: The large number of procedures designed for patients presenting osteoarthritis of the trapezio-metacarpal (TMC) joint indicates that none of them are completely satisfactory. The new generation of non cemented hidroxyapatite coated (HAC) prosthesis made us reconsider the use of this type of implants in patients who require total arthroplasty of the thumb TMC joint.

Objective: To show the results obtained in a series of selected patients presenting TMC joint osteoarthritis who were managed by implantation of a non cemented HAC prosthesis.

Material and methods: We performed a retrospective study over 34 patients (38 prosthesis) presenting TMC joint osteoarthritis with a follow-up period ranging between 6 months and 8 years. The mean age was 60 years of age. All patients were managed by implantation of a HAC total arthroplasty (Roseland).

Postoperatively, the first column was immobilized in a neoprene splint for one month. Physical therapy was started one week after surgery. Clinical evaluation focused on the first web opening, thumb opposition, pinch and grasp strength, pain, patient satisfaction and return to work/leisure time activities.

Results: Almost all patients had satisfactory clinical results. Bone integration was confirmed by CT. Six patients (15.79%) showed radiological images of loosening located in all cases at the MC stem but with no clinical significance at the latest follow-up. 7 patients (18.42%) showed some type of complication: 1 case (2.63%) of infection (which underwent arthrodesis), 1 case (2.63%) of painful scar and 5 cases (13.16%) of reflex sympathetyc dystrophy (RSD) (3 of them related to length of the first column greater than 2 mm compared to the contralateral side).

Discussion/Conclusion: In almost all patients, when joint disease is limited to the TMC joint, there is enough bone stock and there are not too many osteophytes so a total non cemented arthroplasty can be considered in selected patients and satisfactory results can be expected. In addition, insertion of a non cemented HAC prosthesis gives the possibility to reconvert this procedure to any other type of technique in case of failure. The authors would like to remark the importance of patient selection as well as the importance of the postoperative length of the first column due to its association with the possible appearance of RSD postoperatively.

Study design: retrospective clinical study .

Objective: To study radiological late results after posterior stabilization of thoracolumbar fractures with internal fixation. To know factors related with loss of correction and hardware failure.

Summary of background data: The posterior approach using an internal fixator is a standard procedure for stabilizing the injured thoracolumbar spine. None of the surgical techniques used was able to maintain the corrected the kyphosis angle.

Methods: Forty-five patients with thoracolumbar fractures were included in the study. The inclusion criterion was the presence of fracture through the T11-L3 vertebrae without neurologic compromise. The Load-sharing classification has been used for all patients to determine the fracture severity. Surgical techniques (short or long instrumentation) , preoperative and postoperative radiographs ( Cobb technique) and follow-up records of all patients were reviewed carefully from the time of surgery until final follow-up assessment.

Results: 13 patients were treated using short-segment instrumentation (two disc spaces) and 32 patients with long-segment instrumentation (more than two disc spaces). The mean follow-up was 3.4 years (range 1 to 11 years). The mean preoperative Cobb angle was 16.1 degrees and after surgery the mean angle was 6.8° representing an average correction of 9.2 ° . At follow-up assessments the mean Cobb angle was 13.2° representing a loss of correction of 6.4°. Implant failure ( 5 loosening and 8 breakage) was seen in 28.8% of patients: 6/14 (42%) of patients receiving short instrumentation and 7/31 (22%) of patients with long instrumentation. Hardware failure was seen in 53.3% of patients with Cobb angle preoperative more than 20° and in 16.6% of patients with Cobb angle less than 20°.

Conclusions: Radiological behaviour of thoracolumbar fractures treated with posterior instrumentation without anterior support was worse than expected. Hardware failure was related with Cobb angle fracture > 20°, postoperative correction superior than 10° and short pedicular instrumentation technique.