Scaphotrapeziotrapezoid Osteoarthritis Research Articles

D6. Significance and Implications of Partial Trapezoidectomy in Management of Scapho-Trapezio-Trapezoid (STT) Osteoarthritis

PURPOSE: Trapeziectomy with partial trapezoid excision is a common surgical approach for scapho-trapezio-trapezoidal osteoarthritis (STTOA). This study seeks to determine the efficacy of partial trapezoidectomy for the treatment of STTOA. METHODS: All patients within the Cleveland Clinic Healthcare System who received a trapeziectomy with or without partial trapezoidectomy for isolated STTOA between 2003 and 2022 were reviewed. Demographic information, pain scores, and physical findings were recorded. Second metacarpal subsidence was calculated as a ratio of the change in scaphotrapezoid space (base of second metacarpal to scaphoid) preoperatively and postoperatively over the preoperative scaphotrapezoid space. Differences in subsidence and correlation between subsidence and pain scores were assessed between the two groups. RESULTS: Sixty-seven patients who underwent 76 trapeziectomies were included. Of these, 37 underwent a partial trapezoidectomy. The average age at the time of surgery was 64 years (48-86), and 58 patients were female. Median follow-up time was 3 months (IQR=3). 81% of patients with partial trapezoidectomy had second metacarpal subsidence with a median subsidence of 14%(IQR=18), compared to 72% of patients in the trapeziectomy only group who had a median subsidence of 15%(IQR=30) (p=0.34). Pain scores decreased from 6 to 2 in the partial trapezoidectomy group (p<0.001) and from 7 to 3 in the trapeziectomy only group (p<0.001). There was no significant correlation between subsidence and pain in either group (p=0.301, p=0.729). CONCLUSION: Trapeziectomy with and without partial trapezoidectomy reduced pain, but neither procedure was more effective than the other. Subsidence was not found to be a significant indicator of postoperative pain.

Research progress in etiology and clinical diagnosis and treatment of scaphotrapeziotrapezoid osteoarthritis

To summarize the research progress of scaphotrapeziotrapezoid osteoarthritis (STT OA) and its etiology and clinical treatment. The domestic and foreign literature on STT OA in recent years was reviewed and the research progress was summarized. STT OA is a common OA, which is highly prevalent in postmenopausal women and diagnosed by wrist X-ray films. The current treatment methods include conservative treatment and surgery. Among them, the conservative treatment can relieve clinical symptoms, but the long-term effectiveness is not ideal. In surgical treatment, scaphoid arthrodesis can effectively relieve wrist pain, but it sacrifices part of the range of motion and grip strength of the wrist, and there is a risk of fusion failure. Distal scaphoid resection and trapezium resection have the advantages of short operation time, simple operation, less damage to the joint capsule and ligament, and shorter postoperative external fixation time, but they lead to changes in carpal bone alignment and dorsal intercalated segmental instability. Arthroplasty can provide pain relief while restoring grip strength and preserving wrist motion, but there is a risk of dislocation of the prosthesis. At present, there is no gold standard for the STT OA treatment. The short-term effectiveness of arthroplasty and arthroscopic distal scaphoid resection are satisfactory, but the long-term effectiveness needs further study.

Pyrocarbon Disc Interposition Arthroplasty (PyroDisk) for the Treatment of Carpometacarpal Thumb Joint Osteoarthritis.

Preoperatively, review radiology images to confirm that the osteoarthritis is limited to the thumb CMC joint and that all appropriate tools for inserting the disc are available before beginning surgery. Next, the patient is placed with their arm on an arm rest. The CMC thumb joint is exposed via a dorsal longitudinal skin incision, sparing the dorsal radial nerve branches and the radial artery and accompanying venes. The capsule is opened with an H-incision. With 2 parallel cuts to the joint surface, the articular surfaces of the joint are removed. After resection of the articular joint surfaces, the residual width and height of the joint space after resection are measured. The central point in the joint surfaces is marked for the bone tunnels. With an awl, tunnels are created from the center of the joint surface to the proximal (trapezial bone) and distal (first metacarpal bone) and the dorsal side. The implant size is measured with the trial implants for correct size of the disc. A tendon strip of either APL (abductor pollicis longus) or FCR (flexor carpi radialis) tendon is harvested for use securing the disc. The disc is secured with the tendon strip from proximal through the trapezium, through the disc and distal through the first metacarpal, and is secured to itself at the trapezial bone. The position is checked under fluoroscopy. When the disc in the right position, the joint capsule and skin are closed and a plaster cast is applied with the thumb in abduction. Alternative treatments include hemitrapeziectomy without interposition; full trapeziectomy, with or without ligament reconstruction and/or tendon interposition; and joint resurfacing prostheses. The advantage of pyrocarbon disc interposition arthroplasty over other treatment options is the preservation of the STT joint1. Therefore, the procedure is minimally harming the surrounding anatomy despite open surgery and has a high success rate in reducing pain while preserving function and strength. The risk of complications is comparable with that of other CMC joint arthroplasty techniques. A relatively high survival rate has been reported at a mean follow-up of 7 years (range, 5 to 12 years). In cases of recurrent pain, all other surgical options remain possible ("no bridges are burned"). The main disadvantage is the cost of the disc. Our recent study of this technique showed good patient-reported outcomes, pain reduction, patient satisfaction, and preservation of strength and range of motion at a mean follow-up of 7 years1,2. The survival rate was 91%, with 3% failing as a result of disc dislocation. Other reasons of failure were STT osteoarthritis and pain without a specific cause. Preoperatively, make sure that only the CMC thumb joint has osteoarthritis and that the STT joint does not. In cases in which it is unclear whether the osteoarthritis is isolated to the CMC thumb joint, perform computed tomography to make certain10.Only a few millimeters of bone must be resected from the first metacarpal base and the distal trapezium. Both bone cuts must be made parallel to each other and perpendicular to the longitudinal axis of the first metacarpal bone.Bone tunnels must be exactly centered in the cut joint surfaces for proper implant positioning and to decrease the chance of subluxation.Size the implant properly and check movement and stability. OR = operating roomFCR = flexor carpi radialisAPL = abductor pollicis longusPRWHE = Patient-Rated Wrist and Hand EvaluationDASH = Disabilities of the Arm, Shoulder and Hand QuestionnaireMHQ = Michigan Hand QuestionnaireROM = range of motionFU = follow-upCRPS = complex regional pain syndromeLRTI = ligament reconstruction and tendon interpositionMRI = magnetic resonance imagingCT = computed tomography.

The INCA® implant to treat isolated scaphotrapeziotrapezoid osteoarthritis: Preliminary results at a minimum 2 years’ follow-up

We report results with the INCA® distal scaphoid pole resurfacing implant anchored within the scaphoid for isolated scaphotrapeziotrapezoid osteoarthritis. Thirty-five implants in 27 patients (mean age, 69 years) were retrospectively included with a minimum follow-up of 2 years. Outcome criteria were pain (VAS), PROMs (QuickDASH, PRWE and MMWS), wrist motion, pinch and grip strength, and radiographic assessment. The average follow-up was 4.6 years. There was a significant improvement in pain, PROMs, grip and pinch strength. Radial deviation and wrist extension showed slight but significant postoperative decrease (−4° for both). Dorsal intercalated segment instability (DISI) was significantly improved postoperatively (7 cases versus 21 preoperatively). There were 2 cases of implant loosening (6%) within the first 10 months: 1 keel malpositioning and 1 insufficient postoperative immobilization. These findings suggest that the INCA® implant is an effective and reliable medium-term solution for isolated scaphotrapeziotrapezoid osteoarthritis. By restoring scaphoid length and gliding on the trapeziotrapezoid surface, the implant contributes to restoring normal bone alignment of the wrist.

Pyrocardan Scaphotrapeziotrapezoid Joint Arthroplasty for Isolated Osteoarthritis: Results after a Mean Follow-Up of 5 Years.

Background Isolated scaphotrapeziotrapezoid (STT) osteoarthritis (OA) mainly develops in women over 50 years of age in a bilateral manner. Many surgical treatments are available, including distal scaphoid resection with or without interposition, trapeziectomy, and STT arthrodesis. However, there is a controversy about which procedure is the most effective. Purposes The purpose of this study was to report the outcomes of the Pyrocardan implant for treating STT isolated OA at a mean follow-up of 5 years. Patients and Methods Consecutive patients who underwent STT arthroplasty using the Pyrocardan were reviewed retrospectively by an independent examiner who performed a clinical and radiological evaluation. Results The mean follow-up time was 5 years (range 3-8 years). Thirteen patients (76%) were followed for more than 5 years. Between the preoperative assessment and the last follow-up, pain levels decreased significantly. There was no significant difference in the mean Kapandji opposition score. Grip and pinch strengths were 88 and 91% of the contralateral side. The active range of motion in flexion-extension and radioulnar deviation was not significantly different to the contralateral side (119° vs. 121° and 58° vs. 52°, p > 0.1). Functional scores were improved significantly. No identifiable differences were found in the radioscaphoid, capitolunate, and scapholunate angles before and after surgery. In three cases, the preoperative dorsal intercalated scapholunate instability (DISI) failed to be corrected. In one case, DISI appeared after the procedure. There was one asymptomatic dislocation of the implant. Calcification around the trapezium and/or distal scaphoid was found in four cases. The survival rate of the implant without reoperation was 95%. Conclusions In the medium term, Pyrocardan implant is an effective treatment for STT OA as it reduces pain, increases grip strength, and maintains wrist mobility. This is consistent with the results of other published case series using pyrocarbon implants. It provides a high rate of patient satisfaction. Nevertheless, the surgical procedure must be done carefully to avoid STT ligament damage, periarticular calcifications, or dislocation.

Scaphotrapezoid Assessment during Thumb Carpometacarpal Arthroplasty: A Cadaveric Study.

Background Due to limited sensitivity of radiographs for scaphotrapeziotrapezoid (STT) arthritis and the high rate of concurrence between thumb carpometacarpal (CMC) and STT arthritis, intraoperative visualization of the STT joint is recommended during CMC arthroplasty. Purpose We quantified the percentage of trapezoid facet of the scaphotrapezoid (ST) joint that could be visualized during this approach, and compared it to the degree of preoperative radiographic STT arthritis. Methods We performed dorsal surgical approach to the thumb CMC joint after obtaining fluoroscopic anteroposterior, lateral, and oblique wrist radiographs of 11 cadaver wrists. After trapeziectomy, the ST joint was inspected and the visualized portion of the trapezoid articulation marked with an electrocautery. The trapezoid was removed, photographed, and the marked articular surface area and total surface area were independently measured by two authors using an image analysis software. The radiographs were analyzed for the presence of STT arthritis. Results The mean visualized trapezoid surface area during standard approach for CMC arthroplasty was 60.3% (standard deviation: 24.6%). The visualized percentage ranged widely from 16.7 to 96.5%. There was no significant correlation between degree of radiographic arthritis and visualized percentage of the joint ( p = 0.77). Conclusions: On average, 60% of the trapezoid joint surface was visualized during routine approach to the thumb CMC joint, but with very large variability. Direct visualization of the joint did not correlate with the degree of radiographic STT arthritis. Clinical Relevance A combination of clinical examination, pre- and intraoperative radiographs, and intraoperative visualization should be utilized to assess for STT osteoarthritis and determine the need for surgical treatment. Level of Evidence This is a Cadaveric Research Article.

Scaphotrapeziotrapezoid arthrodesis for isolated osteoarthritis: results at a mean 8 years’ follow-up

The aim of this retrospective study was to report medium- to long-term outcome of scaphotrapeziotrapezoid (STT) arthrodesis with staple fixation to treat painful isolated osteoarthritis (OA). Twenty-one consecutive patients (22 wrists) who had undergone STT arthrodesis were retrospectively reviewed by an independent examiner. Clinical and radiological evaluation was performed. At a mean follow-up of 8 years (range 2–20 years), pain levels were significantly decreased, and functional scores were significantly improved. Grip and pinch strength were 86% and 82% of those of the contralateral side. Wrist range of motion in flexion-extension and radial-ulnar deviation was significantly less than on the contralateral side at last follow-up (104° vs. 131° and 38° vs. 55°, respectively). Non-union was found on X-ray in 4 wrists (18%), but in 2 cases showed as partial non-union on CT, with complete scaphotrapezial consolidation; 1 of the 4 wrists required surgical revision. Another patient was re-operated on for symptomatic external staple displacement without non-union. There were 8 cases (36%) of radiographic narrowing of the styloscaphoid joint space; contact between the staple and styloid was found in all 8 cases. Four patients (18%) had narrowing of the scaphocapital joint space; protrusion of the proximal part of the staple into the joint space was noted in all 4 wrists. No differences were found for the radioscaphoid, capitolunate and scapholunate angles before and after surgery. STT arthrodesis with staple fixation to treat isolated STT OA led to a significant reduction in pain, with improved strength and functional scores. To avoid styloid impingement, we recommend systematic styloidectomy. Complete non-union seems to be overestimated on radiographs. Partial non-union with scaphotrapezial union should not be considered as a complication. Level of evidenceIV

Scaphotrapeziotrapezoid osteoarthritis: From the joint to the patient

Scaphotrapeziotrapezoid osteoarthritis (STT OA) is common and often associated with thumb basal joint arthritis. Pain at the base of the thumb on the volar aspect and during resisted extension is characteristic of symptomatic STT OA. If conservative treatment fails, surgical treatment may be offered. In case of STT OA, treatment may range from arthrodesis to trapeziectomy (isolated or associated with ligament reconstruction and/or interposition). Any preoperative intracarpal instability (DISI) can be exacerbated by resecting more than 3 or 4 mm of the distal pole of scaphoid. For peritrapezial osteoarthritis, trapeziectomy is the logical solution, but it exposes the patient to known complications: loss of strength, long recovery, trapeziometacarpal impingement. Initial treatment of thumb basal joint arthritis by arthroplasty is also an option. Treatment of both sites is also possible by interposition of pyrocarbon implants. In all cases (isolated or associated STT OA) and no matter the technique chosen, maintaining the scaphoid height (arthrodesis, resection < 3 mm and/or associated interposition) and performing oblique trapezoidal osteotomy (to prevent scaphoid–metacarpal impingement) are the two crucial elements of surgical treatment.

Mid-term follow-up of surgically treated and healed scaphoid fractures

The aim of this study was to evaluate the mid-term results of surgically treated scaphoid fractures since we were concerned that good results might deteriorate over time due to osteoarthritis or functional impairment. Thirty-three out of 121 surgically treated patients (isolated scaphoid fractures n = 23; scaphoid fractures with concomitant injuries n = 10) were evaluated retrospectively (47–138 months). Five patients (4%) had a non-union after internal fixation and were excluded because of additional treatment. The remaining 83 patients were not available for a follow-up examination. Patients with an isolated scaphoid fracture had a mean extension-flexion of 68°–0°–64°, a radial-ulnar deviation of 27°–0°–41° and a grip strength of 39 kg (corresponding to 87–98% of the uninjured contralateral wrist), while patients with concomitant injuries had a mean extension-flexion of 60°–0°–44°, radial-ulnar deviation of 22°–0°–38° and a grip strength of 42 kg (corresponding to 73–98% of the uninjured contralateral wrist). The Michigan Hand Questionnaire score was 85 and 75 and the Patient-Rated Wrist Evaluation score was 8 and 21, respectively. Fifteen patients had radiological signs of radiocarpal osteoarthritis with a significantly higher occurrence in those who had concomitant injuries compared to those with isolated scaphoid fractures (p < 0.01). There was no significant group difference in scaphotrapeziotrapezoid (STT) osteoarthritis (p = 0.968). One STT osteoarthritis case occurred after plate fixation, one after antegrade screw fixation and 10 after retrograde screw fixation. Surgical treatment of an acute isolated scaphoid fracture has excellent clinical, functional, and radiologic mid-term results, while scaphoid fractures with concomitant wrist injuries have slightly inferior results.

Introducing the “SOAC Wrist”: Scaphotrapeziotrapezoid Osteoarthritis Advanced Collapse

AbstractDespite being the second most common osteoarthritis of the wrist, little is known about scaphotrapeziotrapezoid osteoarthritis. Not all patients with this type of osteoarthritis have symptoms, and, even in those symptomatic patients, the intensity of the complaint is not proportional to the severity of the degeneration. In symptomatic patients, when the conservative treatment fails, grading classifications to help define the surgical treatment are solely based on the joint characteristics, and fail to assess the rest of the carpus.In general, most carpal degenerative processes show the same evolution pattern, which varies according to the initial injury, along with the type of deformity and the inherent instabilities. Thus, we hypothesize that the degenerative evolution due to primary osteoarthritis of the scaphotrapeziotrapezoid joint also follows a logical evolutionary sequence, similar to the one that occurs in cases of scapholunate advanced collapse (SLAC), scaphoid nonunion advanced collapse (SNAC), scaphoid malunion advanced collapse (SMAC), and scaphoid chondrocalcinosis advanced collapse (SCAC), thus resulting in scaphotrapeziotrapezoid osteoarthritis advanced collapse (SOAC). We have divided the SOAC into three groups, and considered that their treatment shall be guided by the evolutionary stage of the disease, and not by the surgeon's preferred technique.

Radioscapholunate fusion for posttraumatic osteoarthritis with consecutive excision of the distal scaphoid and the triquetrum: A comparative study

The aim of this study was to assess the clinical and radiographic outcomes after radioscapholunate (RSL) fusion for posttraumatic osteoarthritis. This was a retrospective, dual-center study of all patients who underwent RSL fusion between 1995 and 2015 for posttraumatic radiocarpal osteoarthritis. Patients were assessed at the final review to determine clinical (pain, wrist range of motion and strength), self-reported (QuickDASH, PRWE and MWS scores) and radiological (degenerative osteoarthritis in the scaphotrapeziotrapezoid (STT) or midcarpal joint and radiocarpal fusion) outcomes. We analyzed three groups: RSL fusion alone, RSL fusion with distal scaphoid excision (DSE) and RSL fusion with DSE and triquetrum excision (TE). Eighty-five patients were included; 10 were lost to follow-up and 11 required conversion to total wrist fusion before the final review. Finally, 64 patients had both clinical and radiographic evaluations. The mean follow-up was 9.1 years (range 1-21.4). RSL fusion alone was performed in 29 patients, RSL fusion with DSE in 23 and RSL fusion with DSE and TE in 12. At the final follow-up, the three groups did not differ in their pain or wrist motion. Overall, 47 (73%) patients were satisfied or very satisfied with the procedure. DSE significantly decreased STT osteoarthritis and radiocarpal non-union. The total wrist osteoarthritis rate after RSL fusion was 55%. RSL fusion is an effective procedure to preserve some motion in wrists with posttraumatic radiocarpal osteoarthritis. DSE prevents STT osteoarthritis by removing bony impingement and increases the fusion rate. Level of evidenceLevel IV, Case series, Therapeutic studies.

The effect of orthoses on the kinematics of the trapeziometacarpal, scaphotrapeziotrapezoidal, and radioscaphoid joints.

The in vivo effect of four different types of thumb and thumb-wrist orthoses on the three-dimensional kinematics of the trapeziometacarpal (TMC), scaphotrapeziotrapezoidal (STT) and radioscaphoid joints was quantified using computed tomography (CT). Eighteen healthy female volunteers were recruited. The dominant hand of each subject was scanned in four thumb and wrist positions, each in three conditions: without orthosis, with a thumb orthosis (Push Ortho and immediate fitting, IMF) and with a thumb-wrist orthosis (Ligaflex Manu and IMF). CT images were analyzed and rotations relative to the more proximal bone were expressed in a joint-specific coordinate system. Without orthosis, the largest STT rotations were observed during radioulnar deviation of the wrist and the STT range of motion (ROM) was significantly lower during wrist flexion-extension. All tested orthoses caused a significant reduction of the ROM at each joint compared to free motion. Significant differences in movement reduction were observed between prefabricated and IMF orthoses.The IMF thumb-wrist outperformed the Ligaflex Manu in terms of immobilization of the radioscaphoid joint. In addition, the IMF thumb orthosis immobilized the TMC joint significantly better during thumb abduction and adduction than the Push Ortho. We found that different types of thumb and thumb-wrist orthotics are effective in reducing joint mobility. While this reduction tends to be higher using IMF compared to prefabricated orthoses, this effect is only significant for the radioscaphoid and TMC joint. The finding that thumb movements do not induce large STT rotations suggests that the thumb does not need to be immobilized in case of isolated STT osteoarthritis.

Does the DISI matter after distal scaphoidectomy with tendon interposition for STT osteoarthritis?

Progression to dorsal extension of the lunate after distal scaphoidectomy was described more than a decade ago. Still, this technique remains a popular choice for surgical treatment of isolated scaphotrapeziotrapezoid osteoarthritis (STT OA). This study aimed to investigate short-term postoperative function, patient satisfaction and radiographic outcomes of distal scaphoidectomy with tendon interposition for isolated STT OA in the wrist. Scaphoid resection width, amount of DISI and postoperative complications were also assessed. We evaluated all distal scaphoidectomies done at our hospital from 2012 to 2018. Postoperative clinical analysis consisted of grip and key pinch strength, joint amplitude, pain on visual analog scale (VAS), hand usability (VAS) and functional scores (QuickDASH and PRWHE scores). On follow-up radiographs, we measured the amount of DISI, resection height and scaphoid working length and compared them to functional scores. Eighteen patients with 21 operated wrists were eligible. Average time to postoperative evaluation was 36 (5–78) months. We observed DISI in 95% of the cases (n=19). A mean increase of 13° (±6) in radiolunate angle was noted when comparing pre- and postoperative radiographs. Neither the amount of DISI nor the resection height was significantly correlated with the functional scores. No revision surgery for advanced wrist collapse was reported. Four concomitant surgeries were needed. Distal scaphoid excision with tendon interposition yields good short-term results in isolated STT OA. While 95% of cases developed a DISI deformity, there were no cases of functional impairment. Longitudinal studies with long-term follow-up are required to further evaluate lunate extension and possible clinical implications.

Current Trends in Operative Treatment of Scaphotrapeziotrapezoid Osteoarthritis: A Survey among European Hand Surgeons.

Objective Based on the available evidence, the optimal surgical treatment for isolated scaphotrapeziotrapezoid oarthritis (STT OA) remains unclear. The purpose of this study is to explore the prevailing surgical practice for isolated STT OA among European hand surgeons. We hypothesized that a considerable variance exists in the current surgical practice among hand surgeons in Europe. Methods An online survey was distributed to 20 participating member states of the Federation of European Societies for Surgery of the Hand (FESSH). Respondents were questioned on their country of practice, surgical experience, preferred surgical procedure, frequency of performing this procedure, factors in decision-making, and other performed surgical procedures. Results Four hundred and sixty-five responses were received with an estimated response rate of 19%. Trapeziectomy with partial trapezoidal excision was the surgical treatment of choice among the participating hand surgeons in Europe (38%), followed by STT joint fusion (30%), and distal scaphoid excision (14%). Conclusion This survey provides an insight into the surgical management of isolated STT OA among hand surgeons in Europe. A wide variety of preferred treatment techniques were found. Evidence concerning the optimal surgical treatment has not been established. Future prospective randomized studies comparing different techniques are warranted.

Functional outcomes after surgical treatment of isolated scaphotrapeziotrapezoid osteoarthritis: Retrospective single-center 24-case series

Isolated scaphotrapeziotrapezoid (STT) osteoarthritis has functional consequences on the wrist. The main objective of our study was to evaluate the functional outcomes of patients managed surgically during the last 12 years at the Toulouse University Hospital, regardless of the surgical technique used, for isolated STT osteoarthritis. We performed a single-center retrospective observational study using the CCAM database. The inclusion criteria were patients treated surgically for isolated STT osteoarthritis who did not respond to conservative treatment, with at least 6 months of clinical and radiological follow-up. Twenty-four patients were treated between 2006 and 2018. Partial arthroplasty of the distal pole of the scaphoid with or without interposition and total trapeziectomy had been performed on these patients. The mean follow-up was 79±46.8 months. The wrist range of motion (ROM) and the Kapandji score were not significantly reduced postoperatively. The mean postoperative QuickDASH score was 29.15±8.46. The mean pain assessed using a visual analog scale was 6.6±1.17 preoperatively versus 1.25±1.51 postoperatively (P=0.003). Statistical subgroup analysis found no predictive factor for a better postoperative QuickDASH score, and no surgical technique was superior at halting the progression of intracarpal misalignment and postoperative ROM. Surgical treatment of isolated STT osteoarthritis resistant to conservative treatment leads to significant functional improvement, particularly in terms of pain, without altering the wrist's overall mobility.

Évaluation fonctionnelle de la prise en charge chirurgicale de l’arthrose scapho-trapézo-trapézoïdienne isolée : série rétrospective monocentrique de 24 patients

Isolated scaphotrapeziotrapezoidal osteoarthritis results in a functional impact of the wrist. The main objective of our study was to evaluate the functional results of patients managed surgically at our University Hospital, regardless of the surgical technique used, during the last twelve years, for isolated scaphotrapeziotrapezoidal osteoarthritis. We performed a monocentric retrospective observational study, using the CCAM database. The inclusion criteria were: surgically treated patient for isolated scaphotrapeziotrapezoidal osteoarthritis resistant to medical treatment, with clinical and radiological follow-up of more than 6 months. Twenty-four patients were cared for between 2006 and 2018. Partial arthroplasty of the distal pole of the scaphoid with or without interposition techniques and total trapeziectomy techniques were found. The mean follow-up was 79 ± 46.8 months. The joint mobilities of the wrist and the Kapandji score were not significantly reduced postoperatively. The mean postoperative Quick DASH score was 29.15 ± 8.46. The mean VAS was 6.6 ± 1.17 preoperatively versus 1.25 ± 1.51 postoperative (P = 0.003). A statistical subgroup analysis did not reveal any predictive factors for a better postoperative Quick DASH score, nor the superiority of a surgical technique on the evolution of intra-carpal misalignment and postoperative mobilities. Our results are similar to those found in the literature. There was a statistically significant improvement in pain after surgical management, with an improvement of 5.35 points of average on the EVA scale (P = 0.003). This represents a significant improvement in the patient's quality of life. Moreover, concerning the global mobilities of the wrist, we did not demonstrate a significant decrease postoperatively. Indeed, we observed a non-significant mean decrease in flexion (−1.09°) and extension (−4.38°) postoperatively. In addition, the Kapandji score for the mobility of the thumb column is unchanged (loss of 0.17 point not significant). Finally, the surgical management does not result in statistically significant radiological carpal bones offsets with an average postoperative capito-lunar angle of 14.34° ± 6.1 (P = 0.131) which remains below 15°. However, a mean postoperative Quick DASH score of 29.15 out of 100 still means that patients remain functionally impaired in daily life despite surgical management. The surgical treatment of isolated scaphotrapeziotrapezoidal osteoarthritis resistant to medical treatment provides a significant functional improvement, particularly in terms of pain without altering the overall mobility of the wrist.

Psychological factors are more strongly associated with pain than radiographic severity in non-invasively treated first carpometacarpal osteoarthritis

Background The aim of this study was to investigate to what extent psychological factors are related to pain levels prior to non-invasive treatment in patients with osteoarthritis of the first carpometacarpal joint. Methods We included patients (n = 255) at the start of non-invasive treatment for osteoarthritis of the first carpometacarpal joint who completed the Michigan Hand Outcome Questionnaire. Psychological distress, pain catastrophizing behavior and illness perception was measured. X-rays were scored on presence of scaphotrapeziotrapezoid osteoarthritis. We used hierarchical linear regression analysis to determine to what extent pain levels could be explained by patient characteristics, X-ray scores, and psychological factors. Results Patient characteristics and X-ray scores accounted for only 6% of the variation in pre-treatment pain levels. After adding the psychological factors to our model, 47% of the variance could be explained. Conclusions Our results show that psychological factors are more strongly related to pain levels prior to non-invasive treatment in patients with osteoarthritis of the first carpometacarpal joint than patient characteristics and X-ray scores, which implies the important role of these factors in the reporting of symptoms. More research is needed to determine whether psychological factors will also affect treatment outcomes for patients treated non-invasively for osteoarthritis of the first carpometacarpal joint. IMPLICATIONS FOR REHABILITATION Pain is the most important complaint for patients with osteoarthritis of the first carpometacarpal joint. Psychological factors are strongly associated with pain levels prior to treatment. Pain catastrophizing behavior appears to be a promising target for complementary treatment in patients with osteoarthritis of the first carpometacarpal joint.

Radioscapholunate Fusion for Radiocarpal Osteoarthritis: Prognostic Factors of Clinical and Radiographic Outcomes.

Background Radioscapholunate (RSL) fusion is a surgical option to manage radiocarpal osteoarthritis. Many authors upgrade the procedure by adding distal scaphoid excision with or without excision of the triquetrum. Our objective was to identify the prognostic factors for good clinical and radiographic outcomes of RSL arthrodesis. Purpose Distal scaphoid excision improves both scaphotrapeziotrapezoidal osteoarthritis and radiocarpal fusion, and excision of the triquetrum is not critical to achieving satisfactory outcomes. Methods In this retrospective and bicentric investigation, all wrists were managed with RSL fusion for posttraumatic radiocarpal osteoarthritis. A total of 85 patients were included and evaluated at the revision by clinical (pain, wrist motion, and strength), functional (Disabilities of the Arm, Shoulder, and Hand questionnaire, Patient-Related Wrist Evaluation score, and Modified Mayo Wrist Score), and radiological (scaphotrapeziotrapezoidal, midcarpal osteoarthritis, and radiocarpal nonunion) examinations. We assessed prognostic factors for clinical and radiographic (osteoarthritis and nonunions) outcomes. Results The average follow-up was 9.1 years (1-21.4). Work-related accidents adversely impacted the clinical outcomes, and distal scaphoid excision significantly improved them and decreased scaphotrapeziotrapezoidal osteoarthritis and nonunion. Neither distal scaphoid excision nor excision of the triquetrum influenced midcarpal osteoarthritis. Radiocarpal fusion was significantly promoted by memory staples and bone grafting. Discussion Distal scaphoid excision should be preferred to improve the functional results while decreasing scaphotrapeziotrapezoidal osteoarthritis and radiocarpal nonunion rates. Excision of the triquetrum appears to be an alternative to radioulnar resection-arthroplasty to solve ulnocarpal impaction syndrome. Strict surgical procedure must be observed to promote RSL fusion combining solid bone fixation and the use of bone graft. Level of evidence This is a level IV, case series, retrospective series.

Arthroscopic-Assisted Suspensionplasty Using the Palmaris Longus Tendon for Osteoarthritis of the Thumb Carpometacarpal Joint

Osteoarthritis of the thumb carpometacarpal joint is common, especially in postmenopausal women. Numerous surgical techniques, including ligament reconstruction, partial or complete trapeziectomy, arthrodesis, and arthroplasty have been introduced. Suspensionplasty combined with trapeziectomy has been introduced to prevent proximal subsidence of the first metacarpal. To prevent excessive release of periarticular capsuloligamentous tissues, resection of the proximal part of the trapezium, and the cosmetically unappealing bump, arthroscopic partial trapeziectomy has been used as a less-invasive treatment option. With advanced techniques and devices, arthroscopic suspensionplasty with the autograft can be performed; thus far, there have been no series reporting on arthroscopic treatment options for this common condition. The purpose of this article is to present a technique for arthroscopic-assisted suspensionplasty using the palmaris longus tendon to reinforce the graft–bone interface, based on the concept of the tension slide technique to treat thumb carpometacarpal osteoarthritis.

Arthroscopic Distal Scaphoid Resection for Isolated Scaphotrapeziotrapezoid Osteoarthritis

To investigate the radiographic and clinical results of arthroscopic distal scaphoid resection for isolated scaphotrapeziotrapezoid (STT) osteoarthritis and analyze the radiographic parameters associated with the functional outcomes. From 2008 to 2014, 17 wrists with symptomatic isolated STT osteoarthritis without carpal deformity underwent arthroscopic distal scaphoid resection. We evaluated visual analog scale (VAS) scores for pain, grip strength, pinch strength, and Patient-Rated Wrist Evaluation (PRWE) scores before surgery and at the final follow-up. We analyzed correlations between the resection height and the radiographic and functional outcomes. The average follow-up period was 42 months. The average VAS score improved from 6.1 ± 2.3 before surgery to 1.7 ± 1.9 after surgery. The average grip strength improved from 18 ± 6 to 19 ± 9 kg, pinch strength from 2.5 ± 1.1 to 4.4 ± 1.7 kg, and PRWE score from 52 ± 23 to 32 ± 24. Carpal deformity (C-L angle of > 15°) was seen in 2 patients at the final follow-up. The deformity was more likely to occur when the resection height was greater than 3 mm. Arthroscopic distal scaphoid resection alone can reduce pain and improve functional outcomes for early to mid-stage isolated STT osteoarthritis in patients without dorsal intercalated segment instability deformity. Resection of greater than 3 mm of the distalscaphoid may result in carpal malalignment. Therapeutic IV.