Prospective Analysis Comparing Arthroplasty With Cadaveric Meniscus Versus Trapezial Resection Alone in Basilar Joint Arthritis

Abstract

HYPOTHESIS: Advanced thumb carpometacarpal (CMC) joint arthritis is widely treated with trapeziectomy. To obviate the need for autologous tissue, maintain thumb length, and reduce the risk of scaphoid impingement, the senior author developed an interposition arthroplasty technique using cadaveric meniscus. We hypothesize that the use of meniscus improves the subject’s outcome and subsequent functionality of the basilar joint arthroplasty procedure when compared with trapeziectomy alone. METHODS: Twenty-one patients with Eaton stage III-IV CMC osteoarthritis underwent arthroplasty with cadaveric meniscus, and seven patients underwent trapeziectomy alone. Postoperative Disability of the Shoulder, Arm and Hand scores, Wong-Baker pain scale score, grip strength, and pinch strength were compared to preoperative scores at 6 weeks and 6 months for each patient. RESULTS: The study group with cadaveric meniscus consisted of 14 females and 7 males, and the control group of 5 females and 2 males. Mean age was similar between the groups at 61.4 (48–72) years for the study group and 65.7 years (56–78) for the control group. Reduction in mean DASH score from preoperatively to six months postoperatively was statistically significant only in the study group (P < 0.05), compared to the control (P = 0.148). Reduction in Wong-Baker scores was statistically significant in both groups (P < 0.05), although there was a more rapid decrease in the study arm. Strength measures similarly improved in both groups, although did not reach significance in either group. There were no surgical complications in either group. CONCLUSION: Joint resurfacing with cadaveric meniscus represents a viable joint salvage option in severe cases of CMC arthritis. Early results suggest that when compared to trapeziectomy alone, interposition arthroplasty with cadaveric meniscus results in a greater reduction in subjective pain and disability scores and similar improvement in strength measures.