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Locking Plate Arthrodesis Compares Favorably with LRTI for Thumb Trapeziometacarpal Arthrosis: Early Outcomes from a Longitudinal Cohort Study

  • Original Article
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HSS Journal ®

Abstract

Background

Trapeziometacarpal arthrodesis (TMA) has been complicated by nonunion and hardware failure.

Questions/Purposes

We hypothesized that modification of the TMA technique with a locking cage plate construct would afford reliable bony union while producing greater hand function than trapeziectomy with ligament reconstruction and tendon interposition (LRTI) at early follow-up.

Methods

We enrolled 36 consecutive patients with trapeziometacapal osteoarthritis (14 TMA patients (15 thumbs), 22 LRTI patients (22 thumbs)). The study was powered to detect a minimal clinically important difference on the QuickDASH questionnaire between groups. Secondary outcomes included Michigan Hand Questionnaire (MHQ), VAS-pain, and EQ-5D-3L scores. Patients were examined to evaluate thumb motion and strength. TMA patients were evaluated clinically and radiographically for union.

Results

Mean follow-up was 15.6 months, and the mean age was 59.2 years. Union was achieved in 14/15 (93%) of TMA thumbs. Improvement in QuickDASH scores was similar after TMA and LRTI (49 to 28 and 50 to 18, respectively). Postoperative patient-rated upper extremity function, health status, and pain were similar between groups. Pinch strength was significantly greater after TMA (5.9 vs 4.7 kg). No differences in thumb or wrist range of motion were observed postoperatively with the exception of greater total metacarpophalangeal joint motion after TMA. Complications after TMA included nonunion (7%), development of symptomatic scaphotrapezotrapezoidal (STT) arthrosis (7%), symptomatic hardware (7%), and superficial branch of the radial nerve (SBRN) paresthesia (7%). Complications after LRTI included subsidence (5%), MP hyperextension deformity (5%), and SBRN paresthesias (5%).

Conclusions

At early follow-up, patient-rated function was similar among patients undergoing TMA and LRTI. TMA produced 25% greater pinch strength compared with LRTI. Despite historical concerns regarding global loss of ROM with arthrodesis, motion was similar between groups. Our observed TMA nonunion rate of 7% is low relative to historically reported nonunion rates (7–16%). Locking cage plate technology affords rigid fixation for TMA with promising early results noting reliable bony union while minimizing complications.

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Acknowledgments

The authors acknowledge the efforts of Andre Guthrie, whose efforts were integral to the management and completion of this study.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, BJC Institute of Health, Suite 5505, 660 South Euclid Ave, Campus Box 8233, St. Louis, 63110, MO, USA

    Nikolas H. Kazmers MD, MSE, K. J. Hippensteel MD, Ryan P. Calfee MD, MSc, Lindley B. Wall MD, Martin I. Boyer MD, MSc, Charles A. Goldfarb MD, Richard H. Gelberman MD & Daniel A. Osei MD, MSc

Authors
  1. Nikolas H. Kazmers MD, MSE
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  2. K. J. Hippensteel MD
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  3. Ryan P. Calfee MD, MSc
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  4. Lindley B. Wall MD
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  5. Martin I. Boyer MD, MSc
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  6. Charles A. Goldfarb MD
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  7. Richard H. Gelberman MD
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  8. Daniel A. Osei MD, MSc
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Corresponding author

Correspondence to Daniel A. Osei MD, MSc.

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Conflict of Interest

Nikolas H. Kazmers, MD, MSE; Kirk J. Hippensteel, MD; and Lindley B. Wall, MD have declared that they have no conflict of interest. Charles A. Goldfarb, MD reports personal fees from Wolters-Kluwer Publishing, independent Expert witness, and ASSH Board Meetings, outside the work. Richard H. Gelberman, MD reports personal fees from JBJS Board of Trustees and Healthpoint Capital: Member of the Scientific Advisory Board, grants from the National Institutes of Health R01 AR062947 and personal fees from Wolters-Kluwer and Medartis, outside the work. Daniel A. Osei, MD, MSc reports grants from NIH KL2 Training Grant, during the conduct of the study. Ryan P. Calfee, MD, MSc reports grants from ASSH and Medartis and personal fees from Depuy/Synthes, outside the work. Martin I. Boyer, MD, MSc reports personal fees from OrthoHelix, Acumed, LLC, Hand Surgical Medicolegal Consultation, LLC, Wolters-Kluwer Publishing, Tournier, and OrthoHelix, outside the work.

Human/Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

Informed Consent

Informed consent was obtained from all patients for being included in the study.

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Disclosure forms provided by the authors are available with the online version of this article.

Funding

This publication was supported by the Institute of Clinical and Translational Sciences Award program of the National Center for Advancing Translational Sciences (NCATS) at the National Institutes of Health (NIH), grant numbers UL1 TR000448, KL2TR000450.

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Level of Evidence: Therapeutic Study-Level III

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Kazmers, N.H., Hippensteel, K.J., Calfee, R.P. et al. Locking Plate Arthrodesis Compares Favorably with LRTI for Thumb Trapeziometacarpal Arthrosis: Early Outcomes from a Longitudinal Cohort Study. HSS Jrnl 13, 54–60 (2017). https://doi.org/10.1007/s11420-016-9527-3

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