Simple Trapeziectomy for Arthrosis of the Basal Joint of the Thumb: 49 Thumbs Reviewed After Two Years.

Abstract

Many different surgical strategies for arthrosis of the carpometacarpal joint of the thumb are described in the literature. In 2010 we changed our routine procedure from an interposition arthroplasty using the abductor pollicis longus (APL) tendon to simple trapeziectomy without suspension or interposition. The purpose of this study was to review the clinical outcome after trapeziectomy and to compare it to those we had achieved with the APL procedure. We examined 49 hands operated with simple trapeziectomy during 2011-2012. Time between operation and review was 26 (15-26) months. Subjective estimation of pain before and after surgery and satisfaction with the general results were evaluated with visual analogue scales. The ability to participate in various activities of daily living before and after the operation were noted and patients completed the Quick-DASH and the PRWHE questionnaires. The mobility of the thumb and wrist were recorded and grip and key pinch strength were measured. The distance between the base of the first metacarpal and the scaphoid was noted on radiographs. There were no significant differences between the present results and those we had achieved with the APL procedure regarding subjective estimation of pain and satisfaction, activities of daily living, mobility, strength and radiographic carpometacarpal distance. For many outcome parameters there was a non-significant trend for better results among the trapeziectomy patients, but increased clumsiness was reported by 20 of them. We conclude that our results with simple trapeziectomy are at least as good as with the APL procedure. However, the considerable number of patients complaining of clumsiness is worrying.