CMC Arthroplasty with STABLYX Implant

Update on Stabylx revision surgeries. See my previous comments for the history. I chose to have the Right Stabylx implant removed and revised after experiencing a very positive outcome with the Left side revision with complete pain relief. Now post op about 3 1/2 months for the Left thumb revision (Left Stabylx implant removal w/ Trapeziectomy and liigament reconstruction, tendon interposition [LRTI] ) and couldn’t be happier with the outcome. The right thumb was revised on 12/15/21 with the same procedure as the left. Now post op day #20. Of note, the Stabylx implant is designed to “grow into the bone” and it did just that. This painful Stabylx implant was in place for over year and required a small osteotomy(cutting the bone) in order to remove the implant. This of course resulted in more post op pain but that has mostly subsided. Range of motion at this date is good. Right gentle wrist flexion, extension is pain free. Gentle distal, middle and proximal thumb joint flexion is excellent with minimal discomfort. The decision to revise was based on the ongoing discomfort from the indwelling Stabylx implants. An interesting finding from both surgeries was that on both of my thumbs, it was discovered that the the Stabylx implant flange had caused the FCR ( flexor carpi radialis ) tendons to rupture. Apparently the flange on the Stabylx implant caused these tendons to fray, in my case, at the attachment point on the thumb, then ultimately to rupture. Very painful and, in my opinion, ultimately the root cause for the pain and the need for the revisions. The FCR tendon is the usual donor for the “anchovy” construction but their ruptures negated their use and required in their absence that the APL tendon be utilized. I will reiterate that these Stabylx implants were ultimately a complete failure in the ability to relieve the CMC arthritis pain, and in my case actually caused more pain and damage. I definitely do not recommend their use. From my personal experiences and in my opinion it should not even be on the market or offered to patients. The failure rate is too high. It’s my opinion that the documented flange design flaw in the Stabylx implant precludes its use for this surgery at this time. I do, however, highly recommend the historically successful Trapeziectomy w/ Arthrex mini tightrope as a reliable procedure (96% success rate) for the relief of this very painful arthritis of the thumb. I hope this thread is helpful to those who are faced with this surgical decision.

Stablyx: I am 8 weeks post-op, and so far my hand has improved beyond what it was pre-surgery, but the jury is still out for a few more weeks. crnaretired - I am sorry you experienced a ruptured tendon. I have had that happen in my elbow - very painful, and I certainly understand why you proceeded as you did. My Stablyx surgeon intentionally cut my cfr tendon during surgery, explaining beforehand that it can interfere with the function of the implant, and I agreed. Perhaps the procedure is evolving.
Only advice I have for anyone with this arthritic condition - do your homework, extensive research, decide what you want to be able to do once the procedure is done. For those who don't require good pinch strength (strong pressure capabilities between the tips of the thumb and index finger), the LRTI, Tight Rope, Speed Spiral (Stanford University) are all good and successful procedures, but in my personal interviews with 3 prominent hand surgeons, (and several other hand surgeons' youtubes of these procedures), they all state that strong pinch strength is lost. I use this strength most every day - I climb for exercise, I build irregularly shaped items of wood, and the loss of the trapezium does not fit well with my needs. I'm 70 (not old, just not young anymore) and I would like to get a few more years out of my hands.
Success rate of these procedure is based solely on the elimination of pain, which they do very well, but they do not result in full original functionality. That is why I took a chance on the Stablyx procedure. It is not for everyone.
So, good luck to you all, and take care.
GregV

Hi Richard! I am curious as to whether or not you can share more about your recovery from the implant? I saw Dr. Rowland today and he is recommending the stablyx implant. While it sounds amazing, he hasn’t done many of these surgeries so I’m a little leery. But I also want proper use of my thumbs back. I’m completely bone on bone in both my thumb joints. Thanks so much in advance!!!

Simone

Gregv here, if I may contribute my 2 cents. I am 12 weeks post op Stablyx on my left hand, and am glad I did this. Most of the swelling is down, a little around the palm side, most dexterity is back, pain level (when I bend it just wrong) is about 3, and I have about 80% of my pinch strength. My hand continues to improve, a little each day. My surgery (done at UCSF) also involved cutting part of the fcr tendon because it apparently gets in the way of the implant. I have not had any loss of mobility because of that. I continue to follow my PT's recommended exercises every day, which have backed off a bit, and at this point there is little that I cannot do. My right hand is getting to be as bad as my left was before surgery, and currently my Stablyx hand is in better shape than my right. I climb at a rock gym for fun and exercise, and I am back to doing that, as well as building a tiny house with my daughter.
I appreciate that the Stablyx procedure does not have really high reviews, but to me it was definitely worth the risk. I wanted the best option to get full use of my thumbs back.
Mayo clinic conducted a clinical trial a couple years ago, but for some reason they will not publish their findings. Second opinions, searching out more experienced surgeons, unfortunately likely involves extensive travel. I am in central Oregon, and the closest surgeon for this procedure was in San Fransisco.
It is not successful for everyone as can be seen in some of the previous entries, but I will likely have my right hand done when the time comes.
Take care, and good luck.

Thanks Greg! I appreciate your feedback for sure! All of this is good to know! I'm happy you're getting good results. My left hand is about as bad as my right already so I will no doubt have both done. I'm going to start with my right as he is going to fuse 2 finger joints at the same time, also due to arthritis. My right hand definitely gives me the most problems with these two fingers being on that hand also. I'm 49 so still have a lot (hopefully lol) of life left to live and really want the use of my hands back!

Hello. Just wanted to post a follow up to my November post . I am about 7 months post op from my Stablyx implant surgery and not happy with my results so far. I have traded occasional excruciating pain for constant achy pain. Hand is always sore and swollen and the basic functions of putting on socks, washing dishes, opening jars, etc are all difficult now . Saw the surgeon a couple weeks ago while the X-rays of the implant looked fine I am now showing increased osteoarthritis of STT joint. I have another follow up appointment scheduled for early May so we can assess progress and discuss removing the implant . The surgeon would like me to get closer to a year post op before making a decision about a revision as he feels that I am still “healing”. Thanks to everyone for posting .

I had my right hand done in November, 2017 and the left in early 2018 as soon as my right was functional (I was 60 yrs old). I couldn't write, grip, or any pinching. The whole year of 2021, I finally realized I was really glad I had it done. I am out of pain but have sum numbness that never went away through the healing process. I can live with that. It took my body that long to heal and adapt, but I would recommend it. Do not dismiss the talent of the surgeon. This is critical. Central Wisconsin has one of our nation's most skilled hand surgeons and he did right by me, that's a fact. Don't give up on the healing process.

simonem, sorry to hear about the extent of your arthritis. Fusing joints has also never appealed to me. I have pretty classic arthritis in both big toes as well as both thumbs. My right foot also had a bunion. Surgeons here only wanted to remove the bunion and fuse the joint - seemed counter-productive to me. So I searched out a surgeon at OHSU (a teaching hospital in Portland, Or) who removed the bunion and cleaned out the joint. 3 months later I was walking straight again, and did a 7 mile difficult terrain hike into the Cascades here - minimal discomfort. I've been walking straight and pain free for the last 3 years. I believe other commenters on this blog have advised second (third and even fourth) opinions, something I always do. My arthritis will come back I'm sure, but I'm trying to squeeze out as much fun as I can, for as long as I can.
Good luck to you, and take care,
Gregv

Thanks Greg for your reply! My daughter is actually having surgery on Thursday to repair her knee and she is seeing one of the best surgeons and PT for aftercare. My surgery date is late March so I'm going to chat with them also regarding this. My index finger and middle finger are the most problematic at the moment, The first knuckle joint on both are severly enlarged and they're also starting to twist. It's pretty miserable.

Hello everyone . I am about 9 months post op from my Stablyx procedure. Had an MRI done recently and the results showed some fluid in the joint and around the implant . No tendon tears which was good news. Opted for a cortisone shot today to see if that will help with the swelling and discomfort . I will see my surgeon again in a couple months so we can discuss my progress and the possibility of removing the implant . Again, thanks for all your posts . The information has been very helpful . Larry