Trapeziometacarpal Osteoarthritis Research Articles

A preliminary report: cementless trapeziometacarpal arthroplasty.

A cementless ball and socket trapeziometacarpal arthroplasty was used for the treatment of Eaton and Littler stage II and III trapeziometacarpal osteoarthritis. Forty-two joints were placed in 36 patients between 1986 and 1992. Five joints in 4 patients required revision. Thirty-four joints in 30 patients were evaluated with a mean follow-up period of 47 months (range, 15-86 months). Of the 33 monitored patients (39 joints), 79% reported good to excellent pain relief and excellent functional improvement and 12% reported poor to fair pain relief and functional improvement. Five joints required revision surgery and constituted 13% of the original arthroplasties. Thirty-three functional tests were graded before and after surgery and improvement was noted in all categories. Dramatic improvement was noted in the typical complaints for trapeziometacarpal joint disease, which are encountered in the activities of daily living. Radiolucent lines were present in 13 of 25 implants (52%), which were radiographically monitored. Radiographic loosening was present in 32%; 12 were around the trapezial component and 1 was around the metacarpal component. Radiographic loosening did not correlate with less satisfactory clinical results. Cementless trapeziometacarpal arthroplasty provides an operative alternative to arthrodesis in properly selected patients with trapeziometacarpal joint osteoarthritis. This joint is not intended to replace excisional or ligament reconstruction tendon interposition arthroplasty in lower demand patients or in those with pantrapezial arthritis. It also is not recommended in patients with rheumatoid arthritis or poor bone stock. It offers the advantages of maintaining excellent motion and stability. The cementless arthroplasty failures can be effectively salvaged by converting them to ligament reconstruction tendon interposition arthroplasty.

First metacarpal osteotomy for trapeziometacarpal osteoarthritis

We report a long-term follow-up of abduction-extension osteotomy of the first metacarpal, performed for painful trapeziometacarpal osteoarthritis. Of a consecutive series of 50 operations, 41 thumbs (82%) were reviewed at a mean follow-up of 6.8 years. Good or excellent pain relief was achieved in 80%, and 93% considered that surgery had improved hand function, while 82% had normal grip and pinch strength, with restoration of thumb abduction. Metacarpal osteotomy was equally successful in relieving symptoms of those with early (grade 2) and moderate (grade 3) degenerative changes. This simple procedure provides lasting pain relief, corrects adduction contracture and restores grip and pinch strength, giving good results with few complications.

First metacarpal osteotomy for trapeziometacarpal osteoarthritis.

We report a long-term follow-up of abduction-extension osteotomy of the first metacarpal, performed for painful trapeziometacarpal osteoarthritis. Of a consecutive series of 50 operations, 41 thumbs (82%) were reviewed at a mean follow-up of 6.8 years. Good or excellent pain relief was achieved in 80%, and 93% considered that surgery had improved hand function, while 82% had normal grip and pinch strength, with restoration of thumb abduction. Metacarpal osteotomy was equally successful in relieving symptoms of those with early (grade 2) and moderate (grade 3) degenerative changes. This simple procedure provides lasting pain relief, corrects adduction contracture and restores grip and pinch strength, giving good results with few complications.

Trapeziometacarpal joint arthrodesis for osteoarthritis: Results of power staple fixation

Fifty-two cases of trapeziometacarpal joint osteoarthritis were treated with arthrodesis using small staple fixation. Eighty-five per cent of the patients were free of pain, with normal thumb. Opposition to the fourth finger tip was always possible and opposition to the little finger tip was observed in 94% of cases. Four patients (7.6%) developed a non-union but only two complained of pain. Arthrodesis with power staple fixation minimizes bone resection and postoperative immobilization (mean 28 days) because of the good stability following this procedure.

Anatomical and biomechanical studies of the pathogenesis of trapeziometacarpal degenerative arthritis

An anatomical and biomechanical study of the stabilizing ligaments of the thumb trapeziometacarpal joint was conducted on 32 hand specimens. Five main ligamentous structures could be identified. The mechanical properties (in particular, strength) of the five ligaments using a strain-rate failure test were determined and evaluated quantitatively. The maximum tensile strength of each ligament was correlated with the condition of the trapeziometacarpal articular cartilage. In studying the anterior oblique ligament, maximum strength decreased from Grade 0 to Grade 1 by 51%. With the first intermetacarpal ligament, the drop from Grade 1 to Grade 2 was 53%. With the posterior oblique ligament, the decrease was closely related to the grade of the deterioration of the trapeziometacarpal articular surface. These three ligaments also significantly decreased in strength with age. Our results may suggest that the anterior oblique ligament, intermetacarpal ligament and posterior oblique ligament play a large role in stabilizing the trapeziometacarpal joint and that the decrease in their strength is related to the pathogenesis of trapeziometacarpal osteoarthritis.

Bilateral osteoarthritis of the trapeziometacarpal joint treated by bilateral tendon interposition arthroplasty

Twenty-four flexor carpi radialis (FCR) tendon interposition arthroplasties of the trapezium for bilateral trapeziometacarpal osteoarthritis were reviewed. Pain was reduced in all cases. Function was improved in all right hands and in 92% of the left hands. FCR tendon interposition arthroplasty for bilateral trapeziometacarpal osteoarthritis yields satisfactory long-term results on both sides.

Extension metacarpal osteotomy in the treatment of trapeziometacarpal osteoarthritis: A biomechanical study

The biomechanical effects of extension metacarpal osteotomy on contact pressures in the trapeziometacarpal joint during lateral pinch were studied in 20 anatomic specimens using pressure-sensitive film. The gross appearance of joint surfaces was classified by severity of arthritic disease and correlated with specimen x-ray films taken before the osteotomy. Extension metacarpal osteotomy effectively unloaded the palmar contact area in nonarthritic and moderately arthritic specimens; primary contact areas and zones of peak pressure were shifted from the diseased palmar compartment to the normal dorsal compartment. In contrast, the pathologically congruent contact pattern seen in end-stage osteoarthritic joints was unaffected by osteotomy. The data demonstrate the efficacy of extension metacarpal osteotomy in unloading the palmar contact areas of normal and moderately arthritic joints but provide no biomechanical rationale for metacarpal osteotomy as originally described in treatment of advanced trapeziometacarpal osteoarthritis.

Pathobiology of articular cartilage in trapeziometacarpal osteoarthritis. II. Surface ultrastructure by scanning electron microscopy

Regional variation in the surface ultrastructure of hyaline cartilage in the osteoarthritic trapeziometacarpal joint was studied by means of scanning electron microscopy. Articular surface degeneration on intact osteochondral specimens was analyzed and correlated with known patterns of gross, histologic, and biochemical disease. The earliest changes were observed in the tangential surface lamina and occurred in areas of chondromalacia in the palmar contact area of the joint. Progressive disruption of this superficial fibrillar layer of the articular cartilage was followed by disorganization of the underlying chondrocytes and matrix. In palmar regions with more advanced chondromalacia and loss of eosinophilic staining, free cellular elements and craters 20–30 μm in diameter, resembling empty chondrocyte lacunae, appeared in conjunction with the absence of any tangential surface meshwork. Eburnated areas demonstrated no fibrillar or cellular elements. Disruption of the protective surface lamina of trapeziometacarpal articular cartilage occurs in a geographic pattern corresponding to joint contact areas and regions of selective biochemical decomposition of proteoglycan matrix. These observations support an interdependent relationship between mechanically induced abrasive surface wear and biochemical matrix degradation in the production of the cartilage lesion of trapeziometacarpal osteoarthritis.

Pathobiology of articular cartilage in trapeziometacarpal osteoarthritis. I. Regional biochemical analysis

Biochemical analysis was performed on hyaline cartilage from four distinct quadrants in surgically harvested osteoarthritic thumb trapeziometacarpal joints and both normal and osteoarthritic cadaver specimens. Chondromalacic surfaces in the palmar contact areas of arthritic specimens were characterized by preferential loss of glycosaminoglycan, retention of collagen, and a shift in glycosaminoglycan subspecies as indicated by an increasing chondroitin sulfate/keratan sulfate ratio. In contrast, articular cartilage from the dorsal portion of arthritic joints biochemically resembled that from both the adjacent normal surfaces of the scaphoid and trapezoid facets and normal postmortem specimens. No significant difference was noted between the biochemical profiles of osteoarthritic surgical specimens and arthritic cadaver specimens. Such selective glycosaminoglycan depletion localized to the contact areas of the joint suggests an interdependent relationship between mechanical factors and biochemical matrix degradation in production of the cartilage lesion of trapeziometacarpal osteoarthritis.

Trapeziometacarpal osteoarthritis: Surgical technique and results of “stabilized resection-arthroplasty”

Since 1973, 212 hands of 179 patients with disabling trapeziometacarpal osteoarthritis were treated with resection-arthroplasty stabilized by capsuloplasty and intermetacarpal ligament construction; 159 patients (180 hands) could be followed up (average, 7.8 years; range, 1 to 17.3 years). Pain relief was excellent in 89%, good in 10%, and fair in 1%. Patients were “delighted” (78%), “satisfied” (18%), “indifferent” (2%), or “disappointed” (2%) with their functional results. Palmar abduction improved 25%. The tip of the thumb reached the fifth metacarpophalangeal joint in 97% of the hands. Grip strength improved 29%; key pinch, 19%; pulp pinch, 24%. First metacarpal was stable in 94% of the cases. Scaphometacarpal space averaged 5.5 mm. There were three complete failures (2%); complications were mild and infrequent. Because of its good, predictable results, “stabilized resection-arthroplasty” is our preferred surgical treatment for osteoarthritic trapeziometacarpal joints.

I. Lessons in dupuytren's disease

No surgical management is better than another regarding functional recovery for trapeziometacarpal joint osteoarthritis. Metacarpophalangeal (MCP) hyperextension, directly due to the shortening of thumb height, appears to be a factor of poor prognosis.MCP hyperextension can be corrected by implantation of a trapeziometacarpal prosthesis (TMP), as opposed to trapeziectomy and ligamentoplasty (TL), and pinch strength is greater with TMP in this indication.Sixty-nine patients (41 TMP and 28 TL) were retrospectively evaluated. The following were evaluated: pain, mobility of the metacarpophalangeal joints, palmar grip and pinch strength. Thumb height was measured on radiographs as a post/preoperative ratio.The mean follow-up was 20 months (6–38). The TMP group showed greater reduction of the metacarpophalangeal hyperextension in all hyperextension groups, especially hypertension >30°, compared with TL. The TMP group provided significant greater pinch strength in all the subgroups with preoperative MCP hyperextension. Patient with postoperative MCP hyperextension had a significant lower grip and pinch strength compared with patient without MCP hyperextension. Radiographic analysis showed that thumb height changes were related to the degree of preoperative hyperextension. Postoperatively, patients with postoperative MCP hyperextension had a significant lower thumb height than patient without MCP hyperextension.Metacarpophalangeal hyperextension appears to be a factor of poor prognosis for surgical treatment of trapeziometacarpal osteoarthritis when it is not managed. TMP provides better metacarpophalangeal stabilization by restoring thumb length and would avoid surgery on the metacarpophalangeal joint. TMP may be recommended in patients having symptomatic trapeziometacarpal joint osteoarthritis and MCP joint hyperextension.III, retrospective observational case control study.

Osteoarthritis of the trapeziometacarpal joint: The pathophysiology of articular cartilage degeneration. II. Articular wear patterns in the osteoarthritic joint

An anatomic and radiographic study of the osteoarthritic trapeziometacarpal joint was conducted on 27 surgical specimens harvested during basal joint arthroplasty. Surface wear patterns were analyzed by hyaline cartilage staining, and relative involvement of trapezium and metacarpal was calculated as the trapezium/metacarpal eburnation ratio. Eburnation occurred only on facing trapeziometacarpal surfaces in contact areas of the palmar compartment. Metacarpal degeneration began at the palmar joint margin adjacent to the beak ligament and extended dorsally, while trapezial degeneration originated on the central palmar slope and spread centrifugally with more advanced disease. Eburnation consistently involved a greater surface area on the trapezium than on the metacarpal in a ratio of nearly 3:1. A decreasing trapezium/metacarpal eburnation ratio correlated closely with worsening radiographic stage. These observations suggest translation of metacarpal on trapezium in the production of arthritic surface lesions and support a hypothesis of pathologic joint instability as the cause of trapeziometacarpal osteoarthritis.

A radiological technique for measurement of the height of the trapezial cavity: Applications in pre- and post-operative assessment in osteoarthritis of the base of the thumb

The authors present an original radiological technique which allows a precise measurement of the height of the trapezial cavity. The measurement is performed on an antero-posterior radiological projection of the trapezio-metacarpal joint in a neutral position, as described by Kapandji. The first point of reference is fixed and consists of a line projected through the radial articular surface of the second metacarpal with the trapezium. Two perpendicular lines to this first point of reference, are then projected respectively from the distal extremity of the scaphoid and the base of the first metacarpal, so defining a space which corresponds to the height of the trapezial cavity. We have used this measurement for assessment of the column of the thumb, in a series of 33 patients operated on for trapezio-metacarpal osteoarthritis (18 patients were treated by trapezectomy, ligamentous stabilisation and tendon interposition following Burton's or Jones technique and 15 patients underwent insertion of a Swanson trapezium implant. Radiologic measurement pre- and post-operatively provided information relative to the change of the height of the trapezial cavity after the two different surgical techniques, and to assess the kinetics of collapse of the trapezial gap following trapezectomy.

The Basal Joint Pain Syndrome

Disabling trapeziometacarpal osteoarthritis is often associated with other skeletal or soft tissue pathology that necessitates simultaneous treatment. In this study of 100 trapezium arthroplasties, 65% of the patients required at least one concurrent operative procedure and, overall, 75% have received treatment for related problems before, during, or after the arthroplasty. In order of frequency, scaphotrapezial arthritis, carpal tunnel syndrome, hyperextension deformity of the thumb metacarpophalangeal joint, trigger digits, and tenosynovitis of the wrist have been the most prevalent concomitant conditions requiring surgery. Awareness that trapeziometacarpal arthritis is frequently the focal site of a widespread inflammatory process involving other structures of the hand--termed herein the "basal joint pain syndrome"--is essential to optimal management of patients with pain at the base of the thumb.

Silicone spacer or tendon spacer for trapezium resection arthroplasty—Comparison of results

A comparison study was done for 25 consecutive trapeziectomies in 21 women with silicone replacements and 25 consecutive trapeziectomies in 24 women without silicone replacements who were reviewed from 1 to 9 years postoperatively. The patients, who ranged from 35 to 75 years of age, were housewives and clerical workers. All had trapeziometacarpal osteoarthritis. Among the patients with silicone replacement of the trapezium, 90% reported pain relief; mean thumb abduction was 42.5 degrees, pronation was 37.5 degrees, and pinch strength averaged 5 kg. Among the patients without silicone replacement after trapeziectomy, 95% reported pain relief; mean thumb abduction was 46.8 degrees, pronation was 41.4 degrees, and pinch strength averaged 4.6 kg. For those patients with only one hand operated upon, pinch strength in that hand averaged 85% that of the opposite hand in patients with silicone trapezial replacement and 82% for those without silicone trapezial replacement. In this patient population, trapeziectomies with or without silicone replacement as treatment for trapeziometacarpal osteoarthritis appear to give similar results.

Rupture of the collateral ligament of the metacarpo-phalangeal joint of the thumb.

Rupture of the collateral ligament of the metacarpo-phalangeal joint of the thumb.