Joint Arthroplasty With Osteochondral Grafting From the Knee for Posttraumatic or Degenerative Hand Joint Disorders

Narihito Kodama; Hiroaki Ueba; Yoshinori Takemura; Mitsuaki Ishida; Shinji Imai; Yoshitaka Matsusue

doi:10.1016/j.jhsa.2015.05.014

Joint Arthroplasty With Osteochondral Grafting From the Knee for Posttraumatic or Degenerative Hand Joint Disorders

J Hand Surg Am. 2015 Aug;40(8):1638-45. doi: 10.1016/j.jhsa.2015.05.014. Epub 2015 Jul 3.

Authors

Narihito Kodama¹, Hiroaki Ueba², Yoshinori Takemura², Mitsuaki Ishida³, Shinji Imai², Yoshitaka Matsusue²

Affiliations

¹ Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan. Electronic address: koda62@belle.shiga-med.ac.jp.
² Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan.
³ Clinical Laboratory Medicine and Division of Diagnostic Pathology, Shiga University of Medical Science, Otsu, Shiga, Japan.

PMID: 26143968
DOI: 10.1016/j.jhsa.2015.05.014

Abstract

Purpose: To describe the operative procedure and report the clinical outcomes of articular surface reconstruction for various hand joint disorders using autologous osteochondral grafts from the knee.

Methods: Ten patients underwent articular surface reconstruction for hand joint disorders with autologous osteochondral grafts from the patellofemoral joint. Mean patient age was 35 years (range, 15-52 y). The patients were followed for an average of 48 months (range, 16-89 mo). Arthroplasty was performed on the metacarpophalangeal joint in 4 cases, and on the proximal interphalangeal joint in 6 cases. The patients' clinical outcomes were evaluated with joint range of motion, visual analog scale (0-10 points), and Disabilities of the Arm, Shoulder, and Hand (DASH) score. Histological examination was performed in 3 cases after surgery.

Results: Graft union was confirmed in all cases without radiographic evidence of resorption or necrosis. Follow-up radiographic examinations showed good graft incorporation without signs of osteoarthritis such as joint space narrowing. The finger flexion-extension arc improved significantly from an average of 21° to 61°. The mean visual analog scale also improved significantly from 7.0 to 1.5. The mean total active motion showed a significant improvement from 151° before surgery to 201° after surgery, and the mean DASH score improved significantly from 33 to 12. There were no significant differences for the arc of finger motion and DASH score between metacarpophalangeal and proximal interphalangeal joint disorders or between hemiarthroplasty and total joint arthroplasty. Histological examination revealed viable chondrocytes in the implanted cartilage.

Conclusions: Autologous osteochondral grafting from the patellofemoral joint provided satisfactory outcomes and may be a useful option for joint surface reconstruction of traumatic or degenerative hand joint disorders.

Type of study/level of evidence: Therapeutic IV.

Keywords: Osteochondral grafting; cartilage lesions; hand disorders; joint arthroplasty.

MeSH terms

Adolescent
Adult
Arthroplasty / methods*
Cartilage / transplantation*
Female
Follow-Up Studies
Hand Joints*
Humans
Joint Diseases / surgery*
Knee Joint*
Male
Middle Aged
Range of Motion, Articular
Retrospective Studies
Treatment Outcome
Young Adult