Pr?valenz der Rhizarthrose

Background

Using x-rays, the age and gender-related prevalence of arthrosis of the trapeziometacarpal joint was determined.

Methods

The radiographs of 235 patients who had presented with an isolated fracture of the distal part of the radius over a 4-year period were evaluated for evidence of trapeziometacarpal arthrosis; 9 patients had bilateral fractures. Trapeziometacarpal arthrosis was determined on radiographic views by 3 physicians. We used a three-grade rating system suitable for standard wrist radiographs. The number of patients with each grade of arthrosis was analyzed according to age and gender.

Results

The radiographic prevalence of trapeziometacarpal arthrosis in our patients (mean age 56 years) was 29%. Signs for arthrosis were first observed in 44-year-old patients and reached a prevalence of 60% in the group older than 70 years. There was a significantly higher prevalence in women (42%) than in men. Higher grades of osteoarthritis were found in women and in older patients. This rating system was demonstrated to have adequate interobserver reliability (??=0.66).

Conclusion

The radiographic prevalence of trapeziometacarpal arthrosis in patients presenting for treatment of a distal radial fracture is age-related. In women and in older patients, trapeziometacarpal arthrosis is more likely to appear and to show a higher grade of joint destruction.     

Association of facet tropism and progressive facet arthrosis after lumbar total disc replacement using ProDisc-L®

Purpose

The purpose of this retrospective study was to examine the association of facet tropism and progressive facet arthrosis (PFA) after lumbar total disc replacement (TDR) surgery using ProDisc-L^®.

Methods

A total of 51 segments of 42 patients who had undergone lumbar TDR using ProDisc-L^® between October 2003 and July 2007 and completed minimum 36-month follow-up period were retrospectively reviewed. The changes of facet arthrosis were categorized as non-PFA and PFA group. Comparison between non-PFA and PFA group was made according to age, sex, mean follow-up duration, grade of preoperative facet arthrosis, coronal and sagittal prosthetic position and degree of facet tropism. Multiple logistic regression analysis was also performed to analyze the effect of facet tropism on the progression of facet arthrosis.

Results

The mean age at the surgery was 44.43 ± 11.09 years and there were 16 males and 26 females. The mean follow-up period was 53.18 ± 15.79 months. Non-PFA group was composed of 19 levels and PFA group was composed of 32 levels. Age at surgery, sex proportion, mean follow-up period, level of implant, grade of preoperative facet arthrosis and coronal and sagittal prosthetic position were not significantly different between two groups (p = 0.264, 0.433, 0.527, 0.232, 0.926, 0.849 and 0.369, respectively). However, PFA group showed significantly higher degree of facet tropism (7.37 ± 6.46°) than that of non-PFA group (3.51 ± 3.53°) and p value was 0.008. After adjustment for age, sex and coronal and sagittal prosthetic position, multiple logistic regression analysis revealed that facet tropism of more than 5° was the only significant independent predictor of progression of facet arthrosis (odds ratio 5.39, 95 % confidence interval 1.251–19.343, p = 0.023).

Conclusions

The data demonstrate that significant higher degree of facet tropism was seen in PFA group compared with non-PFA group and facet tropism of more than 5° had a significant association with PFA after TDR using ProDisc-L^®.     

Prevalence of osteoarthrosis of the trapeziometacarpal joint

BACKGROUND: The age and gender-related prevalence of arthrosis of the trapeziometacarpal joint has been incompletely defined. METHODS: The radiographs of 615 consecutive patients who had presented with an isolated fracture of the distal part of the radius over a two-year period were evaluated for evidence of trapeziometacarpal arthrosis. We used a simple three-grade rating system suitable for standard wrist radiographs. Grade I indicated no or nearly no arthrosis; grade II, obvious arthrosis; and grade III, a totally destroyed joint. This rating system was demonstrated to have adequate intraobserver reliability (average kappa of 0.72, p < 0.001) and interobserver reliability (average kappa of 0.56, p < 0.001). The number of patients with each grade of arthrosis was analyzed according to age and gender. RESULTS: The overall radiographic prevalence of trapeziometacarpal arthrosis in patients with a distal radial fracture increased steadily from the age of forty-one years onward and reached a prevalence of 91% in patients older than eighty years of age. The prevalence increased more rapidly in women than in men; it reached 94% in women who were older than eighty years of age compared with 85% in men who were older than eighty years of age. The prevalence of grade-III trapeziometacarpal arthrosis (a totally destroyed joint) was much greater in women than in men at all age levels; it reached a prevalence of 66% in women older than eighty years of age compared with 23% in men older than eighty years of age. CONCLUSIONS: The radiographic prevalence of trapeziometacarpal arthrosis in patients presenting for treatment of a distal radial fracture is age-related, and trapeziometacarpal arthrosis is more likely to lead to complete joint destruction in women than it is in men.