The Epping resection-suspension arthroplasty procedure. A standard procedure in the operative treatment of trapeziometacarpal osteoarthrosis?

Abstract

The surgical treatment of painful osteoarthrosis of the trapeziometacarpal joint with the Epping technique consists of excision of the trapezium and reconstruction of the first intermetacarpal ligament by using the distally based half of the flexor carpi radialis tendon. This ligament reconstruction procedure aims to prevent proximal migration of the first metacarpal, restore function and stability of the neoarthros. This retrospective study presents operative outcome results after using the Epping arthroplasty technique. The Epping technique has been performed in seventy cases and could be evaluated after a mean follow-up of 34.6 months in 92.4 % of all operated patients. Subjective results were evaluated using patient-based questionnaires such as the Buck-Gramcko-Score and the German Version of the DASH V2.0 questionnaire. Objective and functional outcome analysis including range of motion, strength measurements with the computer-based JAMAR dynamometer and various X-ray views, have been used as further methods of evaluation. Excellent pain relief and very good subjective results with 86 % patient satisfaction have been reported by our patients. The objective outcome analysis demonstrated good functional results with respect to radial abduction (51 degrees) and palmar flexion (45 degrees), and improvement in grip strength, key pinch and pulp pinch. Some patients reported remaining problems with pain during performance of activities of daily life and professional activities. A significant proximal metacarpal migration without correlation to the objective or subjective outcome was found in follow-up X-ray controls. The Epping ligament reconstruction procedure has proven to be a valuable standard procedure after a mid-term follow-up period. Good functional outcome and high patient satisfaction could be achieved, but some patients still remain with problems in different activities. Long-term results still need to be evaluated.