Five-to 18-year follow-up for treatment of trapeziometacarpal osteoarthritis: a prospective comparison of excision, tendon interposition, and ligament reconstruction (original) (raw)
Related papers
The Journal of Hand Surgery, 2004
Purpose: To investigate whether palmaris longus interposition or flexor carpi radialis ligament reconstruction and tendon interposition improved the outcome of excision of the trapezium for the treatment of painful osteoarthritis of the trapeziometacarpal joint. Methods: 183 thumbs with trapeziometacarpal osteoarthritis were randomized for treatment by either simple trapeziectomy, trapeziectomy with palmaris longus interposition, or trapeziectomy with ligament reconstruction and tendon interposition using 50% of the flexor carpi radialis tendon. A K-wire was passed across the trapezial void during each of the 183 surgeries to hold the base of the thumb metacarpal at the level of the index carpometacarpal joint and was retained for 4 weeks in every case. All patients wore a thumb splint for 6 weeks. Each patient had subjective and objective assessments of thumb pain, stiffness, and strength before surgery and at 3 months and 1 year after surgery. Results: The 3 treatment groups were well matched for age, dominance, and presence of associated conditions. Complications were distributed evenly among the 3 groups and no cases of subluxation/ dislocation of the pseudarthrosis were observed. Of the 183 thumbs 82% achieved good pain relief and 68% regained sufficient strength to allow normal activities of daily living at the 1-year follow-up evaluation. Neither of these subjective outcomes nor the range of thumb movement was influenced by the type of surgery performed. Thumb key-pinch strength improved significantly from 3.5 kg before surgery to 4.6 kg at 1 year but the improvement in strength was not influenced by the type of surgery performed. Conclusions: The outcomes of these 3 variations of trapeziectomy were very similar at 1-year follow-up evaluation. In the short term at least there appears to be no benefit to tendon interposition or ligament reconstruction.
The Journal of Hand Surgery, 2006
To report the long-term results of excision of the trapezium and intermetacarpal ligament reconstruction with the extensor carpi radialis longus for thumb trapeziometacarpal osteoarthritis. Methods: Fourteen women and 5 men were retrospectively reviewed after an average of 9 years of follow-up evaluation. Trapeziectomy was performed and the extensor carpi radialis longus was harvested by a dorsoradial approach to reconstruct the intermetacarpal ligament. All patients wore a below-elbow cast for 6 weeks. Each patient had objective and subjective assessments. Thumb shortening was measured in follow-up radiographs. Results: At the final follow-up evaluation, 16 (84%) patients were free of pain and 17 patients (89%) were satisfied with the results. Grip, key strength, and pinch strength improved compared with preoperative values. The trapezium space lost 14% of its height compared with preoperative values. Thumb motion improved, and there were no cases of instability. Conclusions: Resection-arthroplasty of the trapezium with intermetacarpal ligament reconstruction with the extensor carpi radialis longus is an effective procedure that permits motion restoration and pain relief in the trapeziometacarpal joint in the long term without affecting thumb stability. (J Hand Surg 2006;31A:1315-1321
International Journal of Research in Orthopaedics
Background: The purpose of this study is to assess the functional outcome of the cases with advanced thumb carpometacarpal (CMC) arthritis treated with trapeziectomy and ligament reconstruction tendon interposition (LRTI) in terms of visual analogue scale (VAS), disabilities of the arm, shoulder and hand (DASH) score, Kapandji score, range of motion (ROM) of radial and volar abduction of the thumb, grip power, key pinch and the height of the trapezial space.Methods: In a prospective before and after interventional study of 30 patients with the advanced thumb CMC joint arthritis underwent the procedure. An average follows up period was 17.9 months.Results: The mean VAS decreased from 8.17 to 2.70. The mean Kapandji score and DASH score improved from 3.47 and 71.62 preoperative to 8.23 and 14.46 postoperative. Mean ROM for radial and volar abduction increased from 42.57° and 48° to 61°and 64.73° respectively. Mean key pinch power and grip power increased from 2.80 kg and 3.47 kg to 4...
Acta orthopaedica Belgica, 2004
We conducted a prospective study to evaluate the functional status of patients surgically treated by trapeziectomy with intermetacarpal tendon stabilisation. Pain relief, the height of the trapezial cavity, hand impairment, and manual ability were measured in a group of 18 patients at a mean of 2.3 years after surgery. Complete relief of pain was achieved in 89% of our patients. The height of the trapezial cavity was significantly reduced. Hand strength and digital dexterity were not impaired after the operation. Manual ability was significantly improved by the trapeziectomy as demonstrated by the median VAS values of 53.5 before and 95.5 after surgery. The ABILHAND questionnaire revealed that most of the patients were satisfied with the functional results of the trapeziectomy. Based on our findings in this prospective study, it appears that trapeziectomy with intermetacarpal tendon stabilisation relieved pain in almost 90% of patients suffering from trapeziometacarpal osteoarthriti...
Journal of Hand Surgery-american Volume, 2007
Purpose: Thumb carpometacarpal joint arthritis has been commonly treated with some combination of resection of the trapezium and interposition of a spacer using either a biologic or artificial material plus tenodesis to reconstruct the volar oblique ligament. The purpose of this study was to evaluate the biomechanic stability of the classic ligament reconstruction with tendon interposition (LRTI) or without tendon interposition compared with a newly developed 1-piece silicone trapezium implant. Methods: Twelve cadaver arm specimens had the following procedures: resection of the trapezium, tendon interposition, ligament reconstruction, LRTI, and the silicone implant. Biomechanic testing of joint stability was performed with a physiologic loading protocol before and after each procedure. Results: The implant significantly corrected the axial displacement after trapeziectomy and resulted in less radial displacement than LRTI. It significantly reduced angulation of the thumb metacarpal base but resulted in more rotation of the thumb during simulated pinch. There was no significant difference in stability measures between trapeziectomy and LRTI or ligament reconstruction without tendon interposition. Conclusions: We found several biomechanic advantages to the implant compared with LRTI. Advantages include reduction in axial and radial displacement and maintenance of the trapezial space. We attribute these advantages to the effect of the implant as a spacer. The significant rotation with the implant, however, raises questions concerning implant design and fixation. We found no biomechanic advantage to LRTI or ligament reconstruction without tendon interposition over trapeziectomy alone. (J Hand Surg 2007;32A:697-706.
Partial Versus Total Trapeziectomy Thumb Arthroplasty: An Expertise-based Feasibility Study
Plastic and reconstructive surgery. Global open, 2018
There are numerous surgical techniques for the treatment of first carpometacarpal joint osteoarthritis, however, controversy exists as to whether outcomes differ between techniques. This feasibility study aimed to determine if a large-scale, health-related quality of life and functional outcomes study comparing 2 surgical techniques, complete trapeziectomy with ligament reconstruction and tendon interposition (T + LRTI) versus partial trapeziectomy and tendon interposition (PT + TI) arthroplasty, is possible. Patients with advanced stage arthritis (Eaton stages II-IV) of the thumb were invited to undergo either T + LRTI or PT + TI at 1 of the 2 hand surgery practices. Feasibility outcomes included: (1) Process: recruitment rate; (2) Resources: eligibility rate, eligibility criteria, retention, and compliance rates (completion of health-related quality of life questionnaires, Disabilities of the Arm, Shoulder, and Hand, EuroQol-5D-3L, and SF-36, and functional measurements, grip, key...
Trapeziectomy for trapeziometacarpal osteoarthritis
Bone & Joint Open, 2021
Aims The objective of this systematic review was to describe trapeziectomy outcomes and complications in the context of osteoarthritis of the base of the thumb after a five-year minimum follow-up. Methods Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to guide study design, and 267 full-text articles were assessed for eligibility. After exclusion criteria application, 22 studies were included, involving 728 patients and 823 trapeziectomies. Outcomes included pre- and postoperative clinical and radiological characteristics. Complications and revisions were recorded. Results All the studies reported good results regarding pain and range of motion at the last follow-up of 8.3 years (5 to 22); the mean satisfaction rate was 91% (84% to 100%). It was difficult to assess the impact on metacarpophalangeal joint motion in extension with contrary results. The key pinch returned to its preoperative values, whereas tip pinch showed a modest imp...
Partial Versus Total Trapeziectomy Thumb Arthroplasty
Plastic and reconstructive surgery. Global open, 2018
BACKGROUND Osteoarthritis (OA) of the basal joint of the thumb is a common disorder affecting 1 in 4 women and 1 in 12 men. 1 There is a variety of treatment options, both surgical and nonsurgical, depending on the severity of symptoms. Traditionally, treatment has been stage-based 2 ; stage I with ligament reconstruction, stage II and III with 1 of hemitrapeziectomy, joint fusion or implant arthroplasty, Background: There are numerous surgical techniques for the treatment of first carpometacarpal joint osteoarthritis, however, controversy exists as to whether outcomes differ between techniques. This feasibility study aimed to determine if a large-scale, health-related quality of life and functional outcomes study comparing 2 surgical techniques, complete trapeziectomy with ligament reconstruction and tendon interposition (T + LRTI) versus partial trapeziectomy and tendon interposition (PT + TI) arthroplasty, is possible. Methods: Patients with advanced stage arthritis (Eaton stages II-IV) of the thumb were invited to undergo either T + LRTI or PT + TI at 1 of the 2 hand surgery practices. Feasibility outcomes included: (1) Process: recruitment rate; (2) Resources: eligibility rate, eligibility criteria, retention, and compliance rates (completion of health-related quality of life questionnaires, Disabilities of the Arm, Shoulder, and Hand, EuroQol-5D-3L, and SF-36, and functional measurements, grip, key pinch, and tip pinch strength, at 1-week preoperatively and 1, 3, 6, and 12 months postoperatively); (3) Management: determining the practices' commitment to the study; and (4) Scientific: calculation of the variances and treatment effect sizes (ES) of differences between procedures. Data from baseline measurements and 6-month follow-up were used for analysis. Results: Sixty patients were screened, of which 34 (57%) were eligible for surgery. Twenty-one (81%) of the 26 ineligible patients were excluded due to previous or additional planned surgical procedures on the same hand, particularly carpal tunnel release (n = 17). Twenty patients consented; 12 in the T + LRTI and 8 in the PT + TI group. The highest completion rate for the 3 questionnaires and the functional measurements, for both groups was at 6-month time point. Compliance rates for questionnaire completion at 6-months were calculated at 50% and 75% for the T + LRTI and PT + TI group, respectively. Functional measurement completion rate was 50% and 63% for T + LRTI and PT + TI groups, respectively. Treatment ES were group dependent, with Disabilities of the Arm, Shoulder, and Hand, EuroQol-5D-3L usual activities and anxiety/depression showing a large ES in the PT + TI group; the T + LRTI group showed large ES in EQ-5D state of health today. Conclusions: Authors conclude that a large-scale study is feasible and dependent on: (1) increasing sample size to account for the high attrition rate; (2) liberalizing inclusion criteria to include patients with carpal tunnel syndrome; (3) allotting more time at follow-up visits to ensure completion of all measurements; and (4) increasing staff involvement (ie, develop rapport with patients and maintain stability with research assistants).
Plastic and Reconstructive Surgery, 2008
Purpose-Various arthroplasty procedures have been described for the treatment of thumb carpometacarpal joint (CMC) osteoarthritis. The purpose of this study is to determine the outcomes of patients treated with trapeziectomy and a variation of abductor pollicis longus (APL) suspension arthroplasty. Methods-18 consecutive patients with osteoarthritis of the thumb CMC joint were treated by a single surgeon (KCC) with trapeziectomy and APL suspension arthroplasty (21 thumbs). The radial slip of the APL was used for the reconstruction. Prospective outcomes data were collected before the operation, and at 3, 6 and 12 months after surgery. Outcomes were assessed with xrays, grip/key pinch strength, the Jebsen-Taylor test and the Michigan Hand Outcomes Questionnaire (MHQ). Tourniquet time was recorded as well. These results were compared to our retrospective series of 35 flexor carpi radialis (FCR) ligament reconstructive procedures and to the literature. Results-Immediately after surgery, a 32% loss in CMC height was observed and an additional 11% proximal metacarpal migration was observed at 1 year. The mean grip strength was 11.1 kg pre-operatively, and 7.7 kg, 14.3 kg, and 16.7 kg at 3 months, 6 months and 1 year postoperatively. These results were comparable to published series. The Jebsen-Taylor scores showed a improvement from 47 seconds pre-operatively to 40 seconds at 3 months, 34 seconds at 6 months (p=0.03), and 33 seconds at 1 year (p=0.01). The MHQ results demonstrated improvements in all domains. Statistically significant improvements were noted in the domains of overall score from 41 to 67 (p=0.03), activities of daily living from 43 to 66 (p=0.01), work from 41 to 65 (p=0.05), patient satisfaction from 25 to 68 (p=0.01), and pain decreased from 73 to 30 (p<0.01). The mean tourniquet time for the trapeziectomy with APL suspension arthroplasty was 33 minutes, while the mean tourniquet time for trapeziectomy with FCR ligament reconstruction and tendon interposition was 42 minutes (p=0.02).