Does proximal migration of the first metacarpal correlate with remaining pain after trapeziectomy? (original) (raw)
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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.
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...
In vivo kinematics of the first carpometacarpal joint after trapezectomy
2011
First carpometacarpal osteoarthitis is frequent and surgery may be necessary if medical treatment is not efficient. Trapeziometacarpal arthroplasty, trapeziometacarpal arthrodesis and trapezectomy may be proposed. These surgical solutions may modify the carpometacarpal kinematics of the thumb. However, no clinical tools are currently available to assess these modifications. The goal of our study is to assess the TM kinematics, with an optoelectronic system, in patients after trapezectomy. Ten women, average age 53 (range 45 to 67) underwent trapezectomy with ligamentoplasty for trapeziometacarpal osteoarthritis. An optoelectronic device (Polaris 1) was used to analyse postoperative range-ofmotion of the thumb. Splints were used in order to isolate the trapeziometacarpal joint and retroreflective markers were placed both on the splints and on the thumb. Mean flexion-extension, abduction-adduction, axial rotation and circumduction were calculated. Results.-The mean range-of-motion of trapeziometacarpal joint was 50 degrees for flexion-extension, 47 degrees for abduction-adduction and 11 degrees for axial rotation. The mean angle between rotation axes was 90 degrees and the mean distance d between the axes was 3 millimeters. Comparisons between patients and healthy subjects showed no significant differences in flexion-extension, abduction-adduction and axial rotation. Circumduction in patients was reduced compared to healthy subjects. No significant differences were noted between the operated side and the contralateral side. Discussion and conclusion.-Our study showed that this protocol can be used in the postoperative follow-up of patients after trapezectomy. We did not find any significant differences compared to the contralateral side. However, circumduction after trapezectomy was reduced compared to healthy subjects.
The long-term outcome of simple trapeziectomy
Journal of Hand Surgery (European Volume), 2018
The aim of this study was to investigate the long-term outcome of simple trapeziectomy by a single surgeon and to compare this with pre-operative function. Two hundred and five patients completed the shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH) and the EuroQoL five-dimensional questionnaire (EQ-5D) scores at a mean of 8.2 (range 3.5-17) years after simple trapeziectomy. There were no pre-operative scores available, so case controls were selected from our prospective database to compare pre-and post-operative patient-reported outcome measures. The mean QuickDASH score of the post-operative matched group was 37 (SD 17.0) and the mean EQ-5D was 0.56 (SD 0.31). The mean QuickDASH score of the pre-operative group was 54 (SD 17.0). The mean difference in QuickDASH between the pre-and postoperative groups was 17 (95% CI: 8 to 26, p ¼ 0.0003). This study demonstrated a significant and sustained improvement in patient-reported function after simple trapeziectomy. It supports that simple trapeziectomy is a simple, safe and effective treatment for advanced trapeziometacarpal joint arthritis.
Journal of Hand Surgery Global Online, 2020
Total trapeziectomy is the most widely used technique to treat isolated thumb trapeziometacarpal joint osteoarthritis. However, this technique has been associated with proximal migration of the thumb metacarpal, which has led some physicians to consider partial trapeziectomy as a valid alternative. The purpose of this study was to assess whether partial trapeziectomy improves final key pinch strength compared with total trapeziectomy. Methods: We randomized 34 patients with basal thumb osteoarthritis into 2 groups to undergo partial or total trapeziectomy with interposition arthroplasty. Key pinch strength at 12 months was the primary outcome measure. Other variables measured included trapezial space height, range of motion, grip strength, change in key pinch strength, patient-reported outcome measures, and pain. Results: No difference between groups was detected regarding final pinch strength, trapezial space height, grip strength, range of motion, change in pinch strength, patient-reported outcomes (Quick eDisabilities of the Arm, Shoulder, or Hand), or pain. Conclusions: We cannot conclude that partial trapeziectomy provides an advantage over total trapeziectomy at 1 year after surgery. Although trapeziometacarpal space was substantially preserved in the partial trapeziectomy group at 12 months, this difference was not statistically or clinically significant. Type of study/level of evidence: Diagnostic III.
Dose trapeziectomy destabilize the carpus?
Journal of Hand Surgery-british and European Volume, 1998
Trapeziectomy for the treatment of trapeziometacarpal arthritis is an in vivo model of an isolated lesion of the scaphotrapeziotrapeziod ligament complex. We analysed the radiological changes in the wrist retrospectively in 86 patients after trapeziectom . On standardized PA and lateral films the revised carpal height ratio, the radiolunate angle, the scapholunate angle and the ulnar translation were compared pre-
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...
Chirurgie de la main, 2014
Among the surgical options to treat trapeziometacarpal osteoarthrosis, trapeziectomy has been criticized as unable to prevent postoperative collapse of the thumb, causing painful scapho-metacarpal impingement. The implantation of an external minifixator between the first and the second metacarpals for sufficient time has been proposed to maintain the postoperative space created by the bone resection to allow the development of a resistant interposed fibrous tissue. Nineteen patients (16 women, 3 men, mean age 64.5 years) were evaluated at 3.3 years of follow-up after an unilateral trapeziectomy and first metacarpal suspension by external minifixation. Eighty-four percent of the patients were very satisfied with the operation. The mean DASH score was 27.7%, the pain 1.7/10 (Visual Analogue Scale), the opening angle of the first web 58.3° and the Kapandji opposition score 9.5/10. Sonography demonstrated the existence of a strong fibrotic interposed tissue, preventing scapho-metacarpal...