Hemitrapeziectomy with or without interposition – open or arthroscopic? Meta-analysis

Abstract

Hemitrapeziectomy with or without stabilization and with or without interposition has been proposed but rarely used: 36 cases of more than 400 in a personal series. The use of arthroscopy has provided a new start to this technique. In our series 36 open hemitrapeziectomies and stabilization were performed in 34 patients with carpometacarpal osteoarthritis of the thumb. Patient satisfaction, pain, range of motion, pinch and grip strength were assessed at a mean follow-up of 110 months. A DASH-score evaluation and an X ray evaluation were done. We compared the results of a literature review of the open hemitrapeziectomy with or without ligament reconstruction and interposition in 196 cases, with a follow-up of 47.5 months. For the arthroscopic technique of hemitrapeziectomy with or without stabilization and interposition we have analyzed 10 papers. The results of 226 patients have been analyzed at a follow-up of 32.5 months. Open hemitrapeziectomy was performed with stabilization using a tendon strip of FCR or APL and making a transosseous canal through the second metacarpal base or a loop around the insertion of the ECRB. An anchovy tendon interposition of the PL was done or not. Arthroscopic technique with a standard vertical traction of the thumb and a joint distension of saline. Two portals are used to insert a wrist arthroscope, a small joint shaver and a 2.9 mm burr. It is possible to use a thermal capsular shrinkage probe on ligaments and capsule. Hemitrapeziectomy is indicated at the stage II/III of Eaton-classifications. STT-arthritis is a contraindication. Stability may be obtained by different techniques. Residual significant subluxation of the first metacarpal corresponds to a bad result except after a transosseous tendon stabilization. Our study on cadavers shows that in both surgical techniques ligaments of the TM joint are disturbed after performing a hemitrapeziectomy. Subsidence is less decreased in hemitrapeziectomy than in total trapeziectomy. There is no agreement about the consequences of subsidence. There was no difference between cases with or without interposition so we conclude that there is no need to insert any type of device. Motion was similar. The pinch strength seems to be better after transosseous tendon arthroplasty. Smaller scares after arthroscopic technique. Improvement in strength and motion is often present after two years. Open and arthroscopic hemitrapeziectomy are surgical techniques with nearly similar good or excellent results.