Abstract
BackgroundTrapeziometacarpal (TMC) osteoarthritis can be painful and cause disability for patients. Total joint replacement of the TMC joint provides a pseudo arthrosis with good restoration of the thumb motion and pain relief in most patients. But there is also a risk of no improvement following the operation. The purpose of this study was to identify patients at risk of no clinically important improvement following operative treatment of osteoarthritis of the TMC joint.MethodsWe included 287 consecutive patients (225 women, 62 men) treated with total joint replacement of the TMC joint due to osteoarthritis with a mean age of 58.9 years (range 41–80) in a prospective cohort study. We collected information preoperatively and 12 months postoperatively on disabilities of the arm, shoulder and hand score (DASH), grip strength and pain at rest and activity on a visual analogue scale (VAS).Results: We found a statistically significant improvement in DASH from 42.0 to 15.9 (p < 0.001), VAS at rest from 3.5 to 0.6 (p < 0.001), VAS at activity from 7.9 to 2.5 (p < 0.001) and grip strength from 21.6 kg to 27.6 kg (p < 0.001) 12 months after the operation, when analysed as a group. There was an increased risk of no clinically important improvement in hand function for patients with preoperative high preoperative grip strength. Also, we found an increased risk of no clinically important improvement in female patients when using VAS as outcome.ConclusionHowever, we were unable to detect one isolated preoperative predictor as indicator of successful result after operative treatment of TMC osteoarthritis, and as so it was not possible to establish a clinical valid tool for patient selection before surgery.Informed consent was obtained from all patients for being included in the study. The study needed no approval from The Regional Committee of Biomedical Research Ethics as the data was collected, as part of our normal pre- and postoperative clinical pathway, but the study is part of an outcome study of the results after total joint arthroplasty (TJA) of the TMC joint registered in Clinicaltrials.gov (NCT01554748).Trial registrationClinicaltrials.gov (NCT01554748). Registered 15 March 2012.
Highlights
Osteoarthritis of the trapeziometacarpal (TMC) joint is a very common condition with a prevalence of more than 40% in men and women older than 50 years [1] leading to impaired hand function with pain and reduced grip and pinch strength
Overall, we found a statistically significant improvement in DASH, visual analogue scale (VAS) and grip strength 12 months after the operation, when the patients were analysed as a group
We found a general improvement in both VAS at rest, VAS at activity, DASH and grip strength after operation for osteoarthritis in the TMC joint with a total joint replacement
Summary
Osteoarthritis of the trapeziometacarpal (TMC) joint is a very common condition with a prevalence of more than 40% in men and women older than 50 years [1] leading to impaired hand function with pain and reduced grip and pinch strength. Trapeziectomy provides a pseudoarthrosis with good restoration of thumb motion and pain relief in most patients where up to 86% would undergo the same surgery again [3]. Total joint replacement of the TMC joint has been used for years as treatment of TMC joint osteoarthritis. The first TMC implants were cemented [4], but during the last 10–15 years cementless TMC implants have been widely introduced, and improvements in cup and stem designs have increased implant survival [5,6,7]. Total joint replacement of the TMC joint provides a pseudo arthrosis with good restoration of the thumb motion and pain relief in most patients. The purpose of this study was to identify patients at risk of no clinically important improvement following operative treatment of osteoarthritis of the TMC joint
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