Abstract
Various surgical techniques were reported with excellent result for the treatment of trapeziometacarpal joint arthritis. However, the best treatment option was not defined yet. This randomized prospective study compared the result of two surgical techniques: tendon interposition arthroplasty (64 patients) and K. wire distraction (56 patients) after trapeziectomy for stage 3 or 4 osteoarthritis of the trapeziometacarpal joint. After a mean follow-up period of 6.8 (range, 3-10) years it was possible to observe a higher rate of pain relief following trapeziectomy with K. wire suspension, but no significant differences in strength, range of motion and DASH score between the two groups. On lateral unloaded radiographs the height of the space between the base of the thumb metacarpal and the scaphoid showed a mean value of 6.5 mm for both groups; the average distance between the metacarpal base and the trapezium was not statistically significant in the two groups. Complications were observed only in patients treated with trapeziectomy and interposition arthroplasty and were represented by tendinitis of the FCR in 15% of cases. We demonstrate that the trapezium excision and bone space distraction technique requires a smaller incision, a shorter surgical time, an easier surgical technique, and a less painful recovery, maintaining overlapping levels of functional restore.
Highlights
Different authors described several options for the treatment of osteoarthritis of the trapeziometacarpal joint during the years
Thumb metacarpal (TM) arthrodesis requires a prolonged period of immobilization to reach fusion and often results in a decreased range of motion if compared to other techniques.9) with the risk of developing scaphotrapeziotrapezoid and metacarpophalangeal arthritis.10) By observing the good clinical outcome of a failed arthrodesis of the thumb carpometacarpal joint, recently some authors have shown good results by deliberately creating a narrow pseudoarthrosis in the TM joint, this is not recommended for stage IV.11)
TM joint arthroplasty is another option which aims at preserving the length of the thumb with soft tissue balancing but this technique is weighted down by its high rate of complications, such as radiographic subsidence into the trapezium, bone loosening, migration and dislocation, especially when using Moje Acamo CMC 1 implants and Elektra and Pyrocarbon implants.12-15) Good results were presented by Goubau et al.16) after joint replacement with ivory prosthesis (Memometal, Stryker Corporate) in 22 patients included in a 5-year prospective follow-up study
Summary
Different authors described several options for the treatment of osteoarthritis of the trapeziometacarpal joint during the years. The aim of this study is to compare midterm followup results of two different techniques: trapeziectomy with tendon interposition arthroplasty and trapeziectomy with K. wire distraction. Various surgical techniques were reported with excellent result for the treatment of trapeziometacarpal joint arthritis. Methods: This randomized prospective study compared the result of two surgical techniques: tendon interposition arthroplasty (64 patients) and K. wire distraction (56 patients) after trapeziectomy for stage 3 or 4 osteoarthritis of the trapeziometacarpal joint. Results: After a mean follow-up period of 6.8 (range, 3-10) years it was possible to observe a higher rate of pain relief following trapeziectomy with K. wire suspension, but no significant differences in strength, range of motion and DASH score between the two groups.
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