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International Orthopaedics

, Volume 31, Issue 4, pp 547–554 | Cite as

Long term results of surgical intervention for osteoarthritis of the trapeziometacarpal joint

Comparison of resection arthroplasty, trapeziectomy with tendon interposition and trapezio-metacarpal arthrodesis
  • E. E. J. RavenEmail author
  • G. M. M. J. Kerkhoffs
  • S. Rutten
  • A. J. W. Marsman
  • R. K. Marti
  • G. H. R. Albers
Original Paper

Abstract

Trapeziometacarpal osteoarthritis is a common entity, often bilateral and predominantly affecting postmenopausal women. In the case of failure of conservative treatment, surgery is a good option. The aim of this study was to compare three surgical procedures. 63 patients (74 thumbs) with osteoarthritis of the trapezio-metacarpal joint were surgically treated; 54 patients were seen for follow-up, 7 had died and 2 were lost to follow-up. The patients were stratified according to treatment; resection arthroplasty (the joint surface’s of the metacarpal and the trapezium are resected) (18 thumbs), trapeziectomy with tendon interposition (17 thumbs) or trapezio-metacarpal arthrodesis (28 thumbs). Baseline characteristics were comparable in the three groups for mean age at operation, Eaton classification, left right distribution and dominant hands operated. The average follow-up was 13 years for the resection group, 8 years for the trapeziectomy group and 9 years for the arthrodesis group. No statistically significant difference between the three groups was found for the visual analogue pain and satisfaction scale, pain frequency nor DASH score. Patients in the trapeziectomy group had significantly less pain compared to the arthrodesis group (p=0.025). Statistically, radial abduction was significantly better after trapeziectomy compared to resection arthroplasty (p<0.01) or arthrodesis (p=0.01). There was no difference among the three groups in grip and tip pinch strength nor in pain on palpation. None of the patients in the trapeziectomy group needed a re-operation, one patient in the resection arthroplasty group had a re-operation, and 22 patients in the arthrodesis group had one or more re-operations for hardware removal or because of a complication. This study shows that the resection arthroplasty has equally good long term results compared to trapeziectomy combined with tendon interposition or arthrodesis. Resection arthroplasty is performed through a single incision and is technically simple. In our clinic resection arthroplasty is therefore the preferred technique for the treatment of osteoarthritis of the trapeziometacarpal joint.

Keywords

Visual Analogue Score Flexor Carpus Radialis Dash Score Resection Arthroplasty Trapeziometacarpal Joint 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

L’arthrose trapézométacarpienne est fréquente, souvent bilatérale et atteint de façon prédominante les femmes post ménopausées. En cas d’échec du traitement conservateur, la chirurgie est une excellente option de traitement. Le but de cette étude est de comparer trois techniques chirurgicales.

Patients et méthode: 63 patients (74 pouces) présentant une arthrose trapézométacarpienne ont été traités chirurgicalement, 54 patients ont été suivis régulièrement, 7 sont décédés et 2 perdus de vue. Les patients ont été classés en fonction du traitement, résection arthroplastique (18 pouces) trapézectomie avec inter position tendineuse (17 pouces) et arthrodèse 28 pouces. Les données de ces patients étaient comparables dans les trois groupes en ce qui concerne l’âge, l’intervention, la classification d’Eaton, la latéralisation des lésions et la main dominante. Le suivi moyen a été de 13 ans pour le groupe résection, 8 ans pour le groupe trapézectomie et de 9 ans pour le groupe arthrodèse.

Résultats: il n’y a pas de différence significative entre ces trois groupes sur le plan de la douleur et de la satisfaction ainsi que du score DASH. Les patients du groupe trapézectomie, ont significativement moins de douleur si on les compare au groupe arthrodèse (p=0.025). L’abduction est de façon significative plus importante après trapézectomie si on la compare au groupe résection (p<0.01) ou arthrodèse (p=0.01). Il n’y a pas de différence significative dans les trois groupes en termes de force, de serrage, de pince, ni en termes de douleur à la palpation. Aucun de ces patients après trapézectomie n’a nécessité de réintervention alors qu’un patient du groupe résection arthroplastique a dû être réopéré et 22 patients du groupe arthrodèse ont eu une ou plusieurs réinterventions, soit pour ablation de matériel soit du fait d’une complication.

En conclusion, cette étude montre que la résection arthroplastique donne un résultat à long terme équivalent aux autres techniques. La résection arthropastique peut être réalisée par une petite incision, elle est extrêmement simple sur le plan chirurgical. Dans notre établissement, la résection arthroplastique est devenue la technique de choix pour le traitement des arthroses trapézométacarpienne. Niveau d’évidence III–Etude de cohorte rétrospective.

References

  1. 1.
    Alberts KA, Engkvist O (1989) Arthrodesis of the first carpometacarpal joint. 33 cases of arthrosis. Acta Orthop Scand 60:258–260PubMedCrossRefGoogle Scholar
  2. 2.
    Armstrong AL, Hunter JB, Davis TR (1994) The prevalence of degenerative arthritis of the base of the thumb in post-menopausal women. J Hand Surg [Br] 19:340–341CrossRefGoogle Scholar
  3. 3.
    Belcher HJ, Nicholl JE (2000) A comparison of trapeziectomy with and without ligament reconstruction and tendon interposition. J Hand Surg [Br] 25:350–356CrossRefGoogle Scholar
  4. 4.
    Burton RI (1986) Basal joint arthritis. Fusion, implant, or soft tissue reconstruction? Orthop Clin North Am 17:493–503PubMedGoogle Scholar
  5. 5.
    Burton RI, Pellegrini VD Jr (1986) Surgical management of basal joint arthritis of the thumb. Part II. Ligament reconstruction with tendon interposition arthroplasty. J Hand Surg [Am] 11:324–332Google Scholar
  6. 6.
    Caputo RJ, Bennett JB (1993) Power staple fixation in trapeziometacarpal arthrodesis. J Hand Surg [Am] 18:926–929Google Scholar
  7. 7.
    Chamay A, Piaget-Morerod F (1994) Arthrodesis of the trapeziometacarpal joint. J Hand Surg [Br] 19:489–497CrossRefGoogle Scholar
  8. 8.
    Clough DA, Crouch CC, Bennett JB (1990) Failure of trapeziometacarpal arthrodesis with use of the Herbert screw and limited immobilization. J Hand Surg [Am] 15:706–711Google Scholar
  9. 9.
    Comtet JJ, Rumelhart C (2001) Total trapezometacarpal prostheses: concepts and classification study. Chir Main 20:48–54PubMedCrossRefGoogle Scholar
  10. 10.
    Cooney WP, Linscheid RL, Askew LJ (1987) Total arthroplasty of the thumb trapeziometacarpal joint. Clin Orthop 35–45Google Scholar
  11. 11.
    Damen A, van der Lei B, Robinson PH (1997) Bilateral osteoarthritis of the trapeziometacarpal joint treated by bilateral tendon interposition arthroplasty. J Hand Surg [Br] 22:96–99CrossRefGoogle Scholar
  12. 12.
    Damen A, Dijkstra T, van der Lei B, den Dunnen WF, Robinson PH (2001) Long-term results of arthrodesis of the carpometacarpal joint of the thumb. Scand J Plast Reconstr Surg Hand Surg 35:407–413PubMedCrossRefGoogle Scholar
  13. 13.
    Davis TR, Brady O, Dias JJ (2004) Excision of the trapezium for osteoarthritis of the trapeziometacarpal joint: a study of the benefit of ligament reconstruction or tendon interposition. J Hand Surg [Am] 29:1069–1077CrossRefGoogle Scholar
  14. 14.
    Doyle JR (1991) Sliding bone graft technique for arthrodesis of the trapeziometacarpal joint of the thumb. J Hand Surg [Am] 16:363–365CrossRefGoogle Scholar
  15. 15.
    Eaton RG, Littler JW (1969) A study of the basal joint of the thumb. Treatment of its disabilities by fusion. J Bone Joint Surg Am 51:661–668PubMedGoogle Scholar
  16. 16.
    Eaton RG, Littler JW (1973) Ligament reconstruction for the painful thumb carpometacarpal joint. J Bone Joint Surg Am 55:1655–1666PubMedGoogle Scholar
  17. 17.
    Eaton RG, Lane LB, Littler JW, Keyser JJ (1984) Ligament reconstruction for the painful thumb carpometacarpal joint: a long-term assessment. J Hand Surg [Am] 9:692–699Google Scholar
  18. 18.
    Eaton RG, Glickel SZ, Littler JW (1985) Tendon interposition arthroplasty for degenerative arthritis of the trapeziometacarpal joint of the thumb. J Hand Surg [Am] 10:645–654Google Scholar
  19. 19.
    Froimson AI (1970) Tendon arthroplasty of the trapeziometacarpal joint. Clin Orthop 70:191–199PubMedGoogle Scholar
  20. 20.
    Gervis WH (1949) Excision of the trapezium for osteoarthritis of the trapezio-metacarpal joint. J Bone Joint Surg Br 31:537–539Google Scholar
  21. 21.
    Gervis WH, Wells T (1973) A review of excision of the trapezium for osteoarthritis of the trapezio-metacarpal joint after twenty-five years. J Bone Joint Surg Br 55:56–57PubMedGoogle Scholar
  22. 22.
    Hartigan BJ, Stern PJ, Kiefhaber TR (2001) Thumb carpometacarpal osteoarthritis: arthrodesis compared with ligament reconstruction and tendon interposition. J Bone Joint Surg Am 83-A:1470–1478PubMedGoogle Scholar
  23. 23.
    Horlock N, Belcher HJ (2002) Early versus late mobilisation after simple excision of the trapezium. J Bone Joint Surg Br 84:1111–1115PubMedCrossRefGoogle Scholar
  24. 24.
    Hudak PL, Amadio PC, Bombardier C (1996) Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med 29:602–608PubMedCrossRefGoogle Scholar
  25. 25.
    Ishida O, Ikuta Y (2000) Trapeziometacarpal joint arthrodesis for the treatment of arthrosis. Scand J Plast Reconstr Surg Hand Surg 34:245–248PubMedCrossRefGoogle Scholar
  26. 26.
    Kessler I (1973) Silicone arthroplasty of the trapezio-metacarpal joint. J Bone Joint Surg Br 55:285–291PubMedGoogle Scholar
  27. 27.
    Lisanti M, Rosati M, Spagnolli G, Luppichini G (1997) Trapeziometacarpal joint arthrodesis for osteoarthritis. Results of power staple fixation. J Hand Surg [Br] 22:576–579CrossRefGoogle Scholar
  28. 28.
    Manske PR (2004) Commentary: Excision of the trapezium. J Hand Surg [Am] 29:1078–1079CrossRefGoogle Scholar
  29. 29.
    Marti RK (1999) The plate washer technique for carpometacarpal arthrodesis of an old unreduced Bennet’s fracture. In: Ten Duis HJ, Marti RK, van der Werken CH (eds) Problem solving in traumatology. Amsterdam: van der Wees 1:104–105Google Scholar
  30. 30.
    Menon J (1995) Partial trapeziectomy and interpositional arthroplasty for trapeziometacarpal osteoarthritis of the thumb. J Hand Surg [Br] 20:700–706CrossRefGoogle Scholar
  31. 31.
    Mureau MA, Rademaker RP, Verhaar JA, Hovius SE (2001) Tendon interposition arthroplasty versus arthrodesis for the treatment of trapeziometacarpal arthritis: a retrospective comparative follow-up study. J Hand Surg [Am] 26:869–876CrossRefGoogle Scholar
  32. 32.
    Pellegrini VD Jr, Burton RI (1986) Surgical management of basal joint arthritis of the thumb. Part I. Long-term results of silicone implant arthroplasty. J Hand Surg [Am] 11:309–324Google Scholar
  33. 33.
    Schroder J, Kerkhoffs GM, Voerman HJ, Marti RK (2002) Surgical treatment of basal joint disease of the thumb: comparison between resection-interposition arthroplasty and trapezio-metacarpal arthrodesis. Arch Orthop Trauma Surg 122:35–38PubMedGoogle Scholar
  34. 34.
    Swanson AB (1972) Disabling arthritis at the base of the thumb: treatment by resection of the trapezium and flexible (silicone) implant arthroplasty. J Bone Joint Surg Am 54:456–471PubMedGoogle Scholar
  35. 35.
    Tomaino MM, Pellegrini VD Jr, Burton RI (1995) Arthroplasty of the basal joint of the thumb. Long-term follow-up after ligament reconstruction with tendon interposition. J Bone Joint Surg Am 77:346–355PubMedGoogle Scholar
  36. 36.
    Veehof MM, Sleegers EJ, van Veldhoven NH, Schuurman AH, van Meeteren NL (2002) Psychometric qualities of the Dutch language version of the disabilities of the arm, shoulder, and hand questionnaire (DASH-DLV). J Hand Ther 15:347–354PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • E. E. J. Raven
    • 1
    Email author
  • G. M. M. J. Kerkhoffs
    • 2
  • S. Rutten
    • 3
  • A. J. W. Marsman
    • 3
  • R. K. Marti
    • 2
  • G. H. R. Albers
    • 3
  1. 1.Department of Orthopaedics and TraumatologyGelre Ziekenhuizen ApeldoornApeldoornThe Netherlands
  2. 2.Department of Orthopaedics and TraumatologyAcademic Medical CenterAmsterdamThe Netherlands
  3. 3.Department of Orthopaedics and TraumatologyHilversum HospitalHilversumThe Netherlands

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