The surgical management for isolated scaphotrapeziotrapezoid (STT) osteoarthritis : a systematic review of the literature (original) (raw)
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Distal Pole Resection of the Scaphoid for the Treatment of Scaphotrapeziotrapezoid Osteoarthritis
Hand (New York, N.Y.), 2017
Distal pole resection of the scaphoid is one of the surgical techniques applied for the treatment of painful scaphotrapeziotrapezoid osteoarthritis (STT-OA). In this retrospective study, we evaluated midterm outcomes in a consecutive series of patients who underwent distal pole resection of the scaphoid: 13 patients (15 wrists) with a mean follow-up of 4.1 years. We examined objective functional and patient-reported outcome measures. In addition, we assessed the degree of dorsal intercalated segment instability (DISI) and postoperative complications. All patients scored within a normal range on objective functional and patient-reported outcome measures. We observed a mild postoperative DISI deformity with an average lunocapitate angle of 22° (range, 0°-44°), which did not correlate with pain scores. In the opposite wrists, with and without STT-OA, the average lunocapitate angle was 6° (range, 0°-20°). According to this study, midterm results for distal pole resection of the scaphoid...
Acta orthopaedica et traumatologica turcica, 2014
The aim of this study was to describe the surgical technique for resection of the distal quarter of the scaphoid and compare the results of patients treated by resection with patients treated by resection with insertion of a pyrocarbon implant. The study included 9 wrists treated by resection-only and 8 wrists treated by resection with implant. Average follow-up period was 77 (range: 24 to 130) months. Wrist motion and pinch strength were measured and pain was evaluated using the visual analog scale (VAS). Radiographic classification was performed according to Crosby's classification system and the radiolunate (RL) angle was measured pre- and postoperatively. Postoperative VAS pain scores were 2.1 and 2.6 in the in the resection-only and implant group, respectively. Pain scores decreased significantly in both groups (p=0.007 and p=0.01, respectively). The mean RL angle increased from 14º to 30º in the resection-only group (p=0.008). In the STPI implant group, there was an increa...
Results of arthroscopic debridement for isolated scaphotrapeziotrapezoid arthritis
The Journal of Hand Surgery, 2003
Purpose: Symptomatic isolated scaphotrapeziotrapezoid joint arthritis affects approximately 10% of the population. Investigation of the technique of arthroscopic debridement of this joint was done to assess symptom relief achieved and record any resulting postoperative morbidity. Methods: Ten consecutive patients with persistent symptoms were assessed prospectively by a research nurse. Measurements of range of motion and grip strength were obtained before and after surgery. Visual analogue scores for pain and satisfaction levels also were recorded and any limitation to activities of daily living were noted. Results: Good or excellent subjective results were achieved in 9 patients at final review at an average of 36 months (12-65 mo) after arthroscopic debridement. One patient graded the result as fair owing to failure to achieve normal range of motion. All patients showed a reduction in visual analogue pain scores, which improved from a mean of 86 to 14 points. The mean Green and O'Brien wrist scores improved from 63 to 91. Conclusions: Arthroscopic debridement can provide good short-term symptomatic relief for isolated scaphotrapeziotrapezoid arthritis with low risk for surgical complications. (J Hand Surg 2003;28A:000 -000.) (J Hand Surg 2003;28A:729-732.
Journal of Wrist Surgery, 2012
Fractures of the proximal pole of the scaphoid with associated avascular necrosis and nonunion are well known to be problematic. Many techniques for fixation and reconstruction of the proximal pole of the scaphoid have been reported, often with poor results. One of the newer modalities of treatment for these difficult cases is excision of the proximal pole and replacement with a pyrocarbon implant. The ovoid shape of the implant acts as a spacer and repositions itself throughout the range of motion of the wrist. The procedure can be performed arthroscopically, thus reducing the morbidity and allowing the procedure to be a day case. Satisfactory results have been reported in elderly patients, but there is a paucity of literature regarding the outcomes in younger patients. This multicenter retrospective study evaluates the clinical, radiologic, and functional outcomes in patients under the age of 65 years with a minimum follow up of 5 years. There were 14 patients with scaphoid nonunion advanced collapse (SNAC) grade I, II, or III wrists, with a mean age of 53 years and mean follow up of 8.7 years. There were improvements in all of the patient related variables including VAS pain scores (7.5 to 0.7), extension (45°to 60°), flexion (32°to 53°), and grip strength (15.8 to 34.6 kg). Complications included volar subluxation of the implant, which was acutely surgically corrected (1), volar subluxation of the implant, with persistent pain that required a four-corner fusion (2), and secondary radial styloidectomy (3). This technique is an attractive, minimally invasive alternative for nonunion and avascular necrosis resulting from fractures of the proximal pole of the scaphoid. The authors provide details of the technique, including technical suggestions for performing the procedure.
Clinical Radiology, 2001
AIM: To determine the prevalence of isolated scaphotrapeziotrapezoid osteoarthritis in a population presenting to an Accident and Emergency Department of Leicester Royal In®rmary with acute wrist injuries. Also to identify the presence of scapholunate ligament disruption in this patient group and quantify symptoms and loss of function in terms of the modi®ed system of Green and O'Brien, a recognized clinical scoring system. MATERIALS AND METHODS: A total of 1711 radiographs of patients attending the Accident and Emergency Department were prospectively reviewed over a 5-month period. Those patients with isolated scaphotrapeziotrapezoid osteoarthritis were invited for clinical review. RESULTS: Sixteen patients were identi®ed with isolated scaphotrapeziotrapezoid osteoarthritis. Two had a poor Green and O'Brien score and evidence of scapholunate ligament disruption (P 5 0.05). CONCLUSION: Isolated scaphotrapeziotrapezoid osteoarthritis has a prevalence of 1% in a population presenting to an Accident and Emergency Department with acute wrist injuries over the age of 30 years. Isolated scaphotrapeziotrapezoid osteoarthritis may be asymptomatic even though the changes in the joint are severe. Scapholunate ligament disruption is associated with a poor Green and O'Brien score, but is not present in the majority of cases. Higginson, A. P. et al. (2001). Clinical Radiology 56, 372±374.
The Journal of Hand Surgery, 2003
Purpose: To determine and quantify the relationship of osteoarthritis (OA) in the trapeziometacarpal, scaphotrapezial, and scaphotrapezoidal joints; to ascertain the dependability of radiographic assessment of trapeziometacarpal, scaphotrapezial, and scaphotrapezoidal OA; to determine the articular topography of the scaphotrapezio-trapezoidal (STT) joint (composed of the scaphotrapezial and scaphotrapezoidal articulations) using stereophotogrammetry; and to characterize the articular wear patterns of STT OA. Methods: Sixty-nine fresh-frozen human cadaveric hands were staged radiographically and by gross visual examination for the presence of OA in the trapeziometacarpal and STT joints. Twenty randomly selected joints also were evaluated to determine the topography of the STT joint using stereophotogrammetry. Results: Concomitant severe osteoarthritic degeneration was found in the trapeziometacarpal and STT joint in 60% of our specimens. A correlation was found in the severity of OA in the trapeziometacarpal and STT joints. Radiographic and gross visual evaluation of STT OA concurred in 39% of our specimens. Conclusions: The prevalence of concomitant trapeziometacarpal and STT OA, and the uncertainty of radiographic evaluation of STT OA, indicate the need to visualize the STT joint intraoperatively to determine the true degree of degenerative changes present.
Scaphocapitolunate Arthrodesis and Radial Styloidectomy for Posttraumatic Degenerative Wrist Disease
Journal of Wrist Surgery, 2012
Treatment of advanced osteoarthritis after longstanding scaphoid nonunion advanced collapse (SNAC) or chronically destabilized wrists from scapholunate advanced collapse (SLAC) is most commonly treated with four-corner fusion (4CF) or proximal row carpectomy (PRC). 1-4 In each, the scaphoid is excised, reducing the cartilage contact area at the radiocarpal joint. This leads to an increased load across the lunate fossa, as the scaphoid fossa is no longer articulating with the carpus. 5 Therefore, osteoarthritis is a risk, particularly in PRC. 6 The rates of osteoarthritis in 4CF were recently reported at 1% by a meta-analysis, 3 but only one of the eight studies included in the analysis had a greater than 5-year follow up. Additionally, two long-term studies of 4CF 7,8 only follow clinical data and do not review radiologic data or report on the risk of developing progressive osteoarthritis. Therefore the rate of osteoarthritis, particularly in the long term, may be underestimated. The scaphocapitolunate (SCL) arthrodesis is an alternate treatment option in which the majority of the scaphoid is maintained to maximize physiological loading across the radiocarpal joint, while the unaffected intact ulnar joints of the carpus remain mobile. This partial carpal fusion is performed with a radial styloidectomy as well as a partial resection of the distal scaphoid to address radial-sided osteoarthritic changes and painful radioscaphoid impingement. Although the clinical significance of progressive osteoarthritis is unknown, conceptually this procedure may be advantageous in that it maintains a more physiologic joint surface area. It is therefore an appealing treatment option, particularly in the young patient.