Implants of small joints
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The wrist joints are often involved early in rheumatoid arthritis (RA). Small joints of wrist can be affected by hand arthritis leading to pain and deformity of the joints. Pros-thetic development must take in to consideration range of motion, stability, fixation, ease of implantation, biocompatibility and soft tissue resconstruction. The metacarpophalan-geal, interphalangeal and trapeziometacarpal joints each present different problems in the design of prostheses.This thesis focused on the arthritis of the basal joint of the thumb which most often affects middle-aged women. Basal joint is formed by carpometacarpal (CMC) joint and trapezium bone. Several surgical techniques have been described for management of degenarative basal joint changes. These include excision of the trapezium alone, ligament reconstruction with or with out tendon interposition (LRTI) and trapezium resection, arthrodesis and multiple arthroplasty options using biologic and synthetic implants, including silastic prostheses, metal prostheses and allograft interpositions. This study reviewed the literature related to the implants for trapezium bone failures in hand arthritis and also compared the techniques of joint arthroplasty for rheumatoid arthritis (RA). Trapezium bone is the main common area in osteoarthritis of the hand. Researchers found out, successful and durable results with ligament reconstruction with or without tendon interposition.However pinch strength was not satisfactory due to short-ening of the thumb by trapeziectomy. Joint arthroplasty can aid maintenance of the length of the thumb and provide greater pinch strength. Clinical assessments such as rate of mo-tion (ROM), grip and pinch strength can evaluate the quality and durability of each tech-nique. Several studies about silicone implants reported implant wear, synovitis and oste-olysis. Metallic implants resulted in implant loosening and instability. Researchers found out a porous poly-L/D-lactide copolymer implant with an L: D monomer ratio of 96:4 (P (L/D) LA 96/4) resulted significiant strength and can be replaced with fibrous tissue in 2-3 years. Silicone implant is better at palmar stability compared to PLDLA (poly-L/D-lactide copolymer) implant, whereas lack of silicone synovitis and osteolysis are the ad-vantages of the PLDLA implant. For achieving definite results, longer follow-ups are needed for synthetic allograft and PLDLA implants.