Surgical implantable stabilizer sling for basal joint arthroplasty

Abstract

The concepts disclosed herein offer a new simple and reliable reconstructive option for the treatment of first carpal-metacarpal joint (basal joint) arthritis and consists of an intra-articular basal joint stabilizer sling combined with a surgical method of implantation.

Description

[0001]This application claims priority from U.S. Provisional Application 61 / 197,060, filed on Oct. 23, 2008, which is incorporated by reference in its entirety.FIELD OF THE INVENTION[0002]This application relates to an implantable stabilizer sling for the surgical repair and reconstruction of joints, preferably of the hands, in particular the basal joint.BACKGROUND OF THE INVENTION[0003]Degenerative osteoarthritis of the first carpal-metacarpal joint (basal joint) of the thumb is a common, disabling condition, especially in middle-aged women. Investigations show that about 25% of all women and 8% of men in their fifties complain of pain at the base of the thumb, secondary to osteoarthritis. This condition causes joint instability and subluxation, due to incompetence of an important stabilizing structure, the volar oblique ligament, resulting in dorsal subluxation, adduction contracture, and subsequent compensatory metacarpal-phalangeal joint hyperextension deformity. As arthritis pr...

AI Technical Summary

Benefits of technology

[0031]This technique and implant design provides a simpler, less invasive method for basal joint reconstruction with less donor site morbidity, earlier institution of motion post-operatively, faster healing time and resumption of normal activities, and none of the complications which are uniquely associated with other techniques such as improper drill hole placement or fracture associated with the creation of bone tunnels necessary for passing tendon grafts, malalignment of metal or synthetic implant device into bone, implant breakage, pin tract complications, including infection, hypersensitivity or chronic pain from neuroma formation, as well as the potential loss of function including stiffness of the wrist and hand, which may result from more extensive surgery and lengthy immobilization required in procedures which involve sacrificing and utilizing tendons for stabilizing the reconstruction. The technique of this concept appropriately addresses the larger patient population who suffer from advanced, pan-trapezial, basal joint arthritis by removing the entire trapezium and stabilizes the thumb by tethering it to the base of the index metacarpal, maintaining first web space abduction alignment and preserves the resection arthroplasty space by minimizing proximal migration. This method could also be appropriate for patients with earlier stage trapezio-metacarpal arthritis, as the stabilizer sling insertion method and anchorage with a suture anchor into the radial base of the index metacarpal and passage of the suture through two small holes created in the volar-radial articular base of the thumb metacarpal via curved, slightly curved or straight swaged-on needles, or with a second anchor into the base of the thumb metacarpal articular surface, can be accomplished through a small incision, suitable even if the surgeon chooses a hemi-trapeziectomy (partial distal resection) procedure.

[0032]One aspect of this disclosure is directed to the fact that utilization of an intra-articular basal joint stabilizer sling, interwoven with strong non-absorbable or long-lasting absorbable suture, firmly anchored to fixed points of bony insertion at radial base of the index metacarpal ulnarly, and the volar-radial articular base of the thumb metacarpal radially avoids the need for sacrificing a functioning tendon, in part or in whole.

[0033]Another aspect of this disclosure is the distinct

Problems solved by technology

This condition causes joint instability and subluxation, due to incompetence of an important stabilizing structure, the volar oblique ligament, resulting in dorsal subluxation, adduction contracture, and subsequent compensatory metacarpal-phalangeal joint hyperextension deformity.

As arthritis progresses, patients suffer from load-related pain, affecting pinching and gripping activities, and experience weakness, severe dysfunction, reduced mobility, and loss of functionality.

Many of the past described surgical methods require temporary pin fixation of the joint, subsequent pin removal and have been associated with pin tract complications, such as infection, nerve damage, neuroma formation, and these methods which utilize more extensive and often multiple incisions cause increased surgical morbidity.

This procedure can provide pain relief, but is associated with persistent collapse deformity, proximal migration, and weakness.

Each of these methods have had significant failure rates and complications related to implant failure, fracture of the bone interfaces, particulate synovitis, dislocation and loss of stability over time.

Additional problems with the recently developed synthetic fabric inserted into the basal joint include irritation over the synthetic fabric, which is secured to the dorsal base of the thumb metacarpal, potential fixation problems, as well as the fact that the synthetic fabric design only addresses the distal articular surface of the basal joint, leaving the proximal joint (scaphoid-trapezial joint) interface intact.

This particular form of synthetic implant is limited in use for patients with very early arthritis, involving only the distal carpal-metacarpal joint and is not appropriate for the larger cohort of arthritic patients who suffer from arthritis in a more extensive, pan-trapezial (surrounding the trapezium on all articular surfaces) fashion.

Long term results have been excellent with regard to pain relief, but the

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