Interposition suspension arthroplasty according to Epping versus arthrodesis for trapeziometacarpal osteoarthritis

Abstract

BACKGROUND: Arthrodesis and trapezial excision with ligament reconstruction combined with tendon interposition according to Epping have proven to be highly effective techniques for treating primary osteoarthritis of the thumb carpometacarpal joint. To determine which of these two techniques gives better objective and subjective outcomes, the long-term results were compared in similar patients' groups. METHODS: 40 thumbs were prospectively randomized to undergo either carpometacarpal arthrodesis or trapezial excision with ligament reconstruction combined with tendon interposition. 20 cases treated with arthrodesis (group I) and 20 cases treated with arthroplasty (group II) were evaluated 6 months after the operation and then after a mean follow-up of 6.8 years. The outcomes were assessed with the Buck-Gramcko score. RESULTS: 6 months postoperatively, the mean total Buck-Gramcko score was rated significantly better in group I than in group II. But at the last follow-up control, no significant difference was found between both groups. Only group II had significantly better mean scores for palmar abduction and radial abduction. Other mean objective and subjective scores did not differ significantly between the groups. CONCLUSIONS: The after-treatment in patients undergoing arthroplasty lasted longer than in patients after the arthrodesis. It is caused by more complex surgery during Epping's procedure. But the outcomes become similar over a longer period. At the final follow-up control after arthroplasty only older patients subjectively appreciated better functional performance. After this experience we reserve the arthrodesis for younger active and arthroplasty for older patients.