Analyse de la douleur postopératoire et des résultats fonctionnels précoces dans le traitement de la rhizarthrose. Étude prospective comparative de 74 patientes trapézectomie-interposition vs prothèse MAIA®

Abstract

Trapeziectomy has been the basis of basal thumb arthritis surgical treatment since the 1950s. This resection arthroplasty has been continuously refined (soft-tissue interposition, ligament reconstruction, spacer implantation, etc.) without leading to a dramatic outcome improvement. Pain decrease is often satisfying in the long-term, but comfort during the early postoperative period may vary. Those disadvantages of trapeziectomy led to the emergence of total trapeziometacarpal prostheses in the 1970s, with a constant improvement of implant design. Few series have compared those two surgical techniques side by side, and prospective ones are even rarer. We compared total trapeziometacarpal prosthesis and trapeziectomy-interposition in the very short term in two similar groups of female patients, to determine whether prosthesis led to faster recovery or not. We compared a total trapeziometacarpal prosthesis (MAIA®) and trapeziectomy-interposition in the immediate and short-term (6months), for objective, subjective, functional criteria, as well as short-term comfort or discomfort. We prospectively followed two comparable cohorts of 47 and 27 female patients above 50years of age, treated for basal joint arthritis with a constrained trapeziometacarpal joint prosthesis or trapeziectomy-interposition, respectively, between April 2009 and February 2010. The patients were followed postoperatively for 6months. Mobility, pain reduction, satisfaction, strength and functional scores were better in the prosthesis group. The pinch strength improved by 30%, the length of the thumb column was maintained, and better correction of the subluxation was obtained in this group. There were six cases of De Quervain's tenosynovitis and one case of loosening due to trauma. In the short-term, the MAIA® trapeziometacarpal prosthesis gives better outcome than trapeziectomy with interposition. This has to be confirmed in the long-term and after revision surgery that will be likely to occur. Clinical relevanceTherapeuthic 3.