Journal of Hand Surgery - June 2022 - S188

S188
Journal of Hand Surgery (Eur) 47(Supplement 1)
Methods: The design of this cohort study is retrospective,
monocentric and descriptive. 31 prostheses
were implanted by a single surgeon in 26 patients
between 2009 and 2019. Indication for surgery was
advanced primary trapeziometacarpal joint osteoarthritis
(Eaton/Littler II and III). Clinical and radiological
follow-up was performed at a minimum of 24
months. The postoperative assessment included
active range of motion, pain, grip and pinch strength
of the operated and contralateral hand as well as
functional scores (qDASH, MHQ). Survival and complications
were also analyzed.
Results: 10 Elektra prostheses (m 2, f 8) were
implanted between 2009 and 2014, and 21 MOOVIS
prostheses (m 6, f 12) between 2014 and 2019. The
dominant hand was affected in 50% of cases. The
average age at surgery was 64 years (49-80 y.).
Mean follow-up was 94.2 months in the Elektra and
41.4 months in the MOOVIS group. Pain at rest and at
motion (VAS 1-10) was low in both groups with an
average of 0.9/1.9 (Elektra) and 1.3/1.9 (MOOVIS).
Grip/pinch strength and active range of motion
showed good results compared to the non-operated
contralateral hand. Opposition was very good with an
average Kapandji index of 9.6 in both groups. Elektra
tended to achieve slightly better functional scores in
the qDASH and MHQ score (qDASH Elektra 20.6,
MOOVIS 25.9; MHQ Elektra 85.0, MOOVIS 80.2). On a
scale from 1 to 5, most patients were satisfied or
highly satisfied (Elektra 4.9, MOOVIS 4.3). 24 of 25
(96%) of the patients would recommend the procedure.
Metacarpophalangeal hyperextension >15
(Range 15-26) was seen in 6 patients (3 per group)
and receded to 0-5 post-surgery. 3 Elektra prostheses
were revised due to cup loosening and dislocation.
In one patient the cup was replaced after 6
months and again after 51 months. Another received
a cup and neck replacement after 84 months. A secondary
trapeziectomy was performed in one case
after 18 months. In the MOOVIS group only 1 complication
leading to revision surgery was identified. Due
to restricted movement, the exchange of the neck to
a larger size needed to be performed after 15
months. In addition, two patients received surgical
treatment for de Quervain's tenosynovitis after 5
and 9 months. One patient suffered from secondary
impingement which was treated by removal of the
ossifications after 32 months. After the mean
follow-up of 7.9 years in Elektra and 3.5 years in
MOOVIS, cumulative survival was 68.6% vs 95.2%,
respectively.
Conclusions: In this mid- to long-term retrospective
analysis, total joint arthroplasty in primary trapeziometacarpal
joint arthritis results in low pain levels,
good mobility and good clinical function. Patient
satisfaction is overall high. While revision due to
cup loosening occurred more often in patients with
single-mobility implants, no cases of dislocation or
loosening of components were observed in the dualmobility
group.
A-1122 Total Joint Arthroplasty of the
Trapeziometacarpal Joint in WALANT
Lotte Priess Larsen and Torben Baek Hansen
Regional Hospital West Jutland, Holstebro, Denmark
Background: In recent years the concept of WALANT
(Wide Awake Local Anaesthetic No Tourniquet) surgery
has gained in popularity and is increasingly
reported internationally as useful in hand surgery.
WALANT provides benefits for both the patient and
the surgeon, but concerns are present regarding the
use in more complex surgical procedures.
Numerous reports of WALANT in hand surgery are
available but studies describing the use of WALANT
in total joint arthroplasty (TJA) of the trapeziometacarpal
joint are scarce. Purpose/Aim of Study: With
this study we wanted to do a descriptive study of
possible adverse effects and patient acceptance of
WALANT in TJA of the trapeziometacarpal joint and
to compare the duration of the surgical procedure in
WALANT with TJA performed in a bloodless field
under general or regional anaesthesia. Materials and
Methods: In a matched cohort study we compared
duration of the surgery in 42 patients (44 hands) at
mean age 60 (range 48-73) receiving TJA in WALANT
with 42 patients (44 hands) at mean age 59 (range
42-73) receiving TJA in general or regional anaesthesia
with the use of tourniquet. All patients were
operated by the same surgeon in the same institution
and with the same operative team. In the WALANT
group we also registered conversion to general
anaesthesia, intraoperative supplemental local
anaesthesia, use of tourniquet, adverse effects to
the anaesthesia and willingness to repeat (WTR).
Results: There were no conversions to general
anaesthesia, 2 patients required additional local
anaesthesia intraoperative, 1 patient required the
use of tourniquet for 2 minutes, 1 case of adrenalin
rush was registered. WTR in the WALANT group was
100%. There was no significant difference in duration
of surgery in the two groups.
Conclusions: The use of WALANT in thumb TJA surgery
is well tolerated by patients and provides a safe
and reliable method of anaesthesia. WALANT provides
similar working conditions as experienced
with the use of tourniquet during general/regional
Journal of Hand Surgery - June 2022

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