Total Joint Replacement of the Trapeziometacarpal Joint

Abstract

Objective: Total joint arthroplasty of the trapeziometacarpal (TMC) joint is an option for the treatment of degenerative or posttraumatic osteoarthritis (OA) of the thumb. The purpose of this study is to analyze, retrospectively, results over 5 years for patients with OA of the TMC joint treated by arthroplasty with prosthesis. Materials and Methods: Fourteen patients (13 female and 1 male) with OA of the TMC were treated surgically by 1 surgeon from 2000 to 2011. The average age of the patients was 68 years; the youngest was 56 years. Indications for surgery were severe pain, loss of pinch strength, diminished thumb motion, and deformity (Eaton and Littler stages III and IV). Contraindications were history of acute or chronic infection, pantrapezial arthritis, and scaphotrapezial arthritis. The TMC joint of all patients were totally replaced by the “Mathys” cementless bipolar prosthesis. The postoperative care included 3 weeks immobilization of the thumb followed by a rehabilitation program. The average follow-up time was 60 weeks. All patients were evaluated by objective and subjective parameters. Objective assessment included range of motion at the TMC joint (flexion-extension, abduction-adduction, and opposition), grip and pinch strength (tip pinch and key pinch), and loosening. Subjective assessment was pain related to activity of daily living and patient satisfaction after surgery. The residual pain was assessed by visual analogue scale (VAS). Radiographic follow-up included evaluation for migration and loosening of the stem and cup, and joint subluxation as defined by Wachtl. Results: The average range of motion for the TMC joint was 90% when compared with the contralateral side. Power of oppositional pinch was average 4.8 kg (88% of the contralateral hand), tip pinch was 5.6 kg (91% of contralateral hand), and key pinch was 6.2 kg (90% of contralateral hand). Ten patients were free of pain, 3 patients reported mild pain after heavy work (2 of 10 of VAS). Only 1 patient complained of prolonged pain (4 of 10 of VAS) due to the development of trapezoid arthritis. He was successfully treated with a cortisone injection. Osteolysis developed around the 2 cups and the 3 stems of the implants. One patient had posttraumatic loosening of the stem which was revised and tightened. There were no radiological signs of subluxation or periprosthetic fractures. The first 2 patients in this study were surgically treated 16 years ago, and they currently actively work with no complaints or complications. Conclusions: Data from our study with a minimum of 5 years of follow-up demonstrate that patients have excellent, pain-free range of motion, with no significant radiologic signs of implant loosening, periprosthetic osteolysis, or complications. In 1 case of stem loosening, the implant’s design allowed retightening of the central screw of the stem without requiring replacement with a new one. Total joint arthroplasty with prosthesis is a promising option for long-term restoration of the stability and mobility in a compromised TMC joint.