Trapezial arthroplasty with silicone rubber implantation for advanced osteoarthritis of the trapeziometacarpal joint of the thumb (original) (raw)
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Evidence Based Surgical Treatment of Trapeziometacarpal Osteoarthritis
The 8 most commonly used surgical procedures to treat trapeziometacarpal (TMC) joint osteoarthritis (OA) presented in the literature are: 1. volar ligament reconstruction, 2. metacarpal osteotomy, 3. TMC arthrodesis, 4. joint replacement, 5. trapeziectomy, 6. trapeziectomy with tendon interposition, 7. trapeziectomy with ligament reconstruction, and 8. trapeziectomy with ligament reconstruction and tendon interposition (LRTI). Based on an extensive review of the current literature, we conclude that at this time no procedure is superior over another. However, some high level randomized clinical trails (RCT's) showed higher complication rates in the trapeziectomy with LRTI groups compared to trapeziectomy without LRTI. Furthermore, given the lack of high level RCT's on some of the reviewed procedures (volar ligament reconstruction and metacarpal osteotomy for the early stages of OA and TMC arthrodesis and joint replacement for the advanced stages of OA) and based on good results of TMC arthrodesis and total joint prostheses in studies with lower methodological quality, we postulate that there could be differences between the various surgical procedures. Therefore high level RCT's of TMC arthrodesis and total joint prostheses compared to trapeziectomy with long follow-up (> 1 year) are warranted. Additionally, because differences between the various techniques are small, researches should focus on developing more sensitive outcome measures.
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...
BMC Musculoskeletal Disorders
Background The aim of the study was to evaluate patient reported outcome measures (PROM) before and after trapeziectomy with or without ligament reconstruction and tendon interposition for trapeziometacarpal joint arthritis with special focus on possible differences due to gender, age and surgical method. Methods Data from the Swedish quality registry for hand surgery (HAKIR) was analyzed preoperatively, 3 months and 1 year postoperatively for 1850 patients (mean age 63 years, 79% women). Results One year postoperatively, mean pain at rest was reduced from 50 to 12 of maximum 100. However, pain on load and weakness had not abated to the same extent (mean 30 and 34 of 100, respectively). The mean improvement in PROM did not differ between age groups or gender. The result was similar after trapeziectomy with ligament reconstruction and tendon interposition (86% of the patients) and simple trapeziectomy but few patients were operated with the latter method. Conclusion Pain on load and ...
The Journal of Hand Surgery, 1992
Since 1973, 212 hands of 179 patients with disabling trapeziometacarpal osteoarthritis were treated with resection-arthroplasty stabilized by capsuloplasty and intermetacarpal ligament construction; 159 patients (180 hands) could be followed up (average, 7.8 years; range, 1 to 17.3 years). Pain relief was excellent in 89%) good in 10%) and fair in 1% . Patients were 'delighted" (78%), "satisfied" (18%), "indifferent" (2%), or "disappointed" (2%) with their functional results. Palmar abduction improved 25%. The tip of the thumb reached the fifth metacarpophalangeal joint in 97% of the hands. Grip strength improved 29%; key pinch, 19%; pulp pinch, 24%. First metacarpal was stable in 94% of the cases. Scaphometacarpal space averaged 5.5 mm. There were three complete failures (2%); complications were mild and infrequent. Because of its good, predictable results, "stabilized resection-arthroplasty" is our preferred surgical treatment for osteoarthritic trapeziometacarpal joints. (J HAND SURG 1992;17A:598-604.)
Surgical treatment of trapeziometacarpal joint osteoarthritis
Joints, 2013
Trapeziometacarpal joint osteoarthritis is a common cause of radial-sided wrist pain that prevalently affects women. It is diagnosed on the basis of a thorough history, physical examination, and radiographic evaluation. While radiographs are used to determine the stage of disease, treatment is dependent on the severity of the symptoms. Non-surgical treatment frequently consists of activity modification, non-steroidal anti-inflammatory drugs, splinting and corticosteroid injections. After failure of conservative treatment, various surgical options exist depending on the stage of the disease. These options range from ligament reconstruction or osteotomy, for early painful laxity, to trapeziectomy, arthrodesis and arthroplasty for more severe osteoarthritis. This article reviews the literature supporting the various surgical treatment options and analyzes the surgical techniques most frequently used in the different disease stages.
Journal of Hand Surgery Global Online, 2019
Purpose: Osteoarthritis of the trapeziometacarpal (TMC) thumb joint is one of the most common and debilitating degenerative osteoarthritic conditions of the hand. Two available surgical options include arthrodesis versus arthroplasty; the latter uses complete or partial trapeziectomy. Suspension with a suture button avoids the use of tendon grafts and favors early rehabilitation. Our purpose was to evaluate the long-term results of suspension arthroplasty using the suture button technique in a Colombian cohort. Methods: This was a retrospective study of clinical results of a cohort of patients with osteoarthritis of the TMC joint of the thumb, who were treated with trapezium resection arthroplasty plus suspension with a suture button. We included 15 patients (16 thumbs). Functional recovery and pain level were assessed through the grip and pinch strength tests, range of motion, QuickeDisabilities of the Arm, Shoulder, and Hand (QuickDASH) and Kapandji scores, and visual analog scale score of pain. Trapezial space was measured on preoperative and postoperative x-rays. Results: Average age of patients was 62.4 years; there were 14 women. One patient had bilateral involvement. Preoperative QuickDASH score was 70.45 and EatoneLittler classification of the 16 cases was II in 1, III in 6, and IV in 9 thumbs. Average follow-up was 33.75 months (range, 24e48 months) and average QuickDASH score was 24.7. Grip and pinch strengths were 96.9% and 108.3%, respectively, of the nonsurgical side. Average palmar and radial abduction was 92.8% and 101.1%, respectively of the nonsurgical thumb. Average Kapandji score was 9.33. During the last follow-up, the visual analog scale score was 2 or lower in 83.3% of cases. There was one complication of regional pain syndrome. Conclusions: In our population, TMC arthroplasty with suture button provided good functional results for patients with osteoarthritis of the TMC thumb joint, primarily related to pain relief, satisfaction, and early reincorporation into daily activities. Type of study/level of evidence: Therapeutic IV.
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.