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Basal joint osteoarthritis of the thumb: trapeziectomy, with or without tendon interposition, or total joint arthroplasty? A prospective study

Rhizarthrose du pouce: trapèzectomie avec ou sans interposition tendineuse ou arthroplastie totale? Une étude prospective

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Abstract

Background

There is no consensus in the literature concerning the choice of surgical procedure for thumb basal joint—trapeziometacarpal joint—osteoarthritis.

Method

Three treatments for osteoarthritis of the trapeziometacarpal joint of the thumb were compared: trapeziectomy (N = 22), trapeziectomy with ligament reconstruction and tendon interposition (LRTI) (N = 34) and a total cemented joint arthroplasty (N = 40). The mean follow-up was, respectively, 34, 26 and 26 months.

Results

There were no differences in outcome concerning pain, function and patient’s satisfaction. The DASH score demonstrated less disability in arthroplasties, but statistical significance was not reached. All patients improved in force and range of motion. The keypinch force correlated with the loss of height of the thumb. In the arthroplasty group, 40% of radiological loosening was seen.

Conclusion

Although the outcome of the three procedures was not significantly different, trapeziectomy scored the lowest in all parameters when compared with the LRTI patients. Arthroplasties were better but the high incidence of loosening is frightening for the future.

Résumé

Argument

Il n’existe pas de consensus dans la litérature concernant l’indication du traitement chirurgical dans l’ostéoarthrite de l’articulation basale—la trapézio-métacarpienne—du pouce.

Méthode

Trois traitements de l’ostéoarthrite trapézio-métacarpienne du pouce ont été comparés : la trapéziectomie (N = 22), la trapéziectomie avec reconstruction du ligament et interposition tendineuse (LRTI) (N = 34) et une arthroplastie totale cimentée (N = 40). Le recul moyen était respectivement de 34. 26 et 26 mois.

Résultats

On n’a pas trouvé de différence pour les résultats sur la douleur, la fonction et la satisfaction des patients. Le score DASH a révélé moins d’incapacité fonctionnelle chez les patients traités par arthroplastie, mais sans significativité statistique. Tous les patients ont regagné de la force et de l’amplitude de mobilité. La force de serrage de clé (key-pinch) était corrélée à la diminution de longueur du pouce. Dans les arthroplasties il a été constaté un descellement radiologique dans 40 % des cas.

Conclusion

Bien que le résultat des trois procédures ne soit pas significativement différent, la trapéziectomie a les résultats les moins bons pour tous les paramètres, si l’on compare aux patients traités par LRTI. Les arthroplasties étaient meilleures, mais le haut taux des descellements grève le pronostic ultérieur.

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  1. Department of Orthopedic Surgery, U.Z. Pellenberg, Weligerveld, 1, Pellenberg, 3212, Lubbeek, Belgium

    Luc De Smet & Wouter Sioen

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Correspondence to Luc De Smet.

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De Smet, L., Sioen, W. Basal joint osteoarthritis of the thumb: trapeziectomy, with or without tendon interposition, or total joint arthroplasty? A prospective study. Eur J Orthop Surg Traumatol 17, 431–436 (2007). https://doi.org/10.1007/s00590-007-0219-z

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