Influence de l’espace articulaire sur les résultats fonctionnels des patients subis à l’arthroplastie trapézo-métacarpienne totale versus l’interposition du disque pyrocarboné

Abstract

Osteoarthritis of the thumb is one of the main causes of thumb dysfunction and represents an important limitation of the daily activities of individuals. There is currently a myriad of options for the surgical treatment, however none has proven to be superior regarding pain, function, or quality of life. The aim of the present study is to compare the changes in the trapeziometacarpal joint space resulting from two surgical techniques – interposition with pyrocarbon disc versus total arthroplasty–and to evaluate its influence on pain and hand function.This is a retrospective, observational study that analyzed data from patients who underwent trapeziometacarpal arthroplasty in the last decade. The characteristics evaluated were : age, Eaton-Littler classification, joint space after arthroplasty, type of arthroplasty, pain, grip and forceps strength after surgery, Kapandgi score and quickDASH. Patients were categorized in 2 groups : interposition with pyrocarbon disc – group 1, total arthroplasty – group 2. Data was treated using SPSSv20®. Thirty-six individuals, with mean age of 72 in group 1 and 69 in group 2, 100 % female, were included. In group 1 (n = 12), 7 had grade II and 5 grade III osteoarthritis. After surgery, the mean joint space was 7.56 ± 0.83 mm, the grip strength was 11.5, the digital forceps strength was 3.4, the Kapandji score was 6.6, and the QuickDASH score was 15.86. In group 2 (n = 24), 10 presented grade II and 14 grade III osteoartrhitis. The mean joint space was 8.32 ± 1.4 mm, the grip strength 13.3, the digital forceps force 4.35, the Kapandji score 8.7 and the QuickDASH score 17.26. The mean pain on the visual analogue scale was 2.2 and 2.59 for groups 1 and 2, respectively. The joint space in group 2 is superior to that of group 1. Although QuickDASH was worse in group 2, the remaining variables were overall better, suggesting that total arthroplasty may be superior to the pyrocarbon disc. This may be explained by the greater joint space achieved after total arthroplasty, allowing a greater range of movements and a better functional results. It is not possible from this study to conclude whether the differences between joint space resulting from the two techniques may be responsible for differences in functional results, considering that no statistically significant results were obtained. According to current literature, there is no significant difference in functional results between both procedures, and it is not clear if joint space can influence these results.