Skip to main content

Advertisement

SpringerLink
Log in

Midterm results after modified Epping procedure for trapeziometacarpal osteoarthritis

  • Handsurgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background and purpose

Various surgical procedures have been proposed for the treatment of trapeziometacarpal joint (TMJ) osteoarthritis. Despite an overall satisfactory outcome in most cases, some patients complain about inadequate performance at work, due to instability of the TMJ. We present a cross-sectional study of patients with TMJ arthritis who underwent a modified Epping procedure for increased TMJ stability.

Methods

71 patients underwent a modified Epping procedure with a flexor carpi radialis tendon sling stabilizer. 59 patients were followed up after a mean time of 38 months. Residual pain was evaluated by visual analog scale. Functional outcome was quantified by pinch and grip strength, static two-point discrimination test, as well as DASH outcome scoring. Quality of life measures included patients’ perceived satisfaction, activities of daily living (ADL), grip/pinch force and manual performance at work.

Results

85 % of the patients regained full or partial manual performance during labor. Strength and ADL improved or remained the same in 81 %. In cases of a unilateral treatment, no difference in grip between the operated and nonoperated hand was observed. Mean tip pinch strength was 2.8 kg for the operated and 3.6 kg for the nonoperated hand. Mean pain level during rest was 0.98, 0.95 during mild activity, and 3.70 during strenuous activity. Mean DASH score was 26.6.

Conclusion

The great majority of patients who underwent this novel procedure benefited from an unaffected or improved work performance, due to good TMJ stability combined with adequate motion for ADL. Less favorable results were seen in patients with accompanying hand pathologies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Fuchs S, Mönikes R, Wohlmeiner A et al (2006) Intra-articular hyaluronic acid compared with corticoid injections for the treatment of rhizarthrosis. Osteoarthr Cartil 14:82–88. doi:10.1016/j.joca.2005.07.016

    Article  PubMed  CAS  Google Scholar 

  2. Haara MM, Heliövaara M, Kröger H et al (2004) Osteoarthritis in the carpometacarpal joint of the thumb. Prevalence and associations with disability and mortality. J Bone Joint Surg Am 86-A:1452–1457

    PubMed  Google Scholar 

  3. Leclère FMP, Jenzer A, Hüsler R et al (2012) 7-year follow-up after open reduction and internal screw fixation in Bennett fractures. Arch Orthop Trauma Surg 132:1045–1051. doi:10.1007/s00402-012-1499-2

    Article  PubMed  Google Scholar 

  4. Pellegrini VD (1991) Osteoarthritis of the trapeziometacarpal joint: the pathophysiology of articular cartilage degeneration. I. Anatomy and pathology of the aging joint. J Hand Surg Am 16:967–974

    Article  PubMed  Google Scholar 

  5. Bettinger PC, Berger RA (2001) Functional ligamentous anatomy of the trapezium and trapeziometacarpal joint (gross and arthroscopic). Hand Clin 17:151–168

    PubMed  CAS  Google Scholar 

  6. Lee AT, Williams AA, Lee J et al (2013) Trapezium trabecular morphology in carpometacarpal arthritis. J Hand Surg Am 38:309–315. doi:10.1016/j.jhsa.2012.10.038

    Article  PubMed  Google Scholar 

  7. Ghavami A, Oishi SN (2006) Thumb trapeziometacarpal arthritis: treatment with ligament reconstruction tendon interposition arthroplasty. Plast Reconstr Surg 117:116e–128e. doi:10.1097/01.prs.0000214652.31293.23

    Article  PubMed  Google Scholar 

  8. Davis TRC, 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 29:1069–1077. doi:10.1016/j.jhsa.2004.06.017

    Article  PubMed  Google Scholar 

  9. Rab M, Gohritz A, Gohla T et al (2006) Ergebnisse nach Resektions-Suspensions-Arthroplastik bei Rhizarthrose: Vergleich der Abductor pollicis longus- mit der Flexor carpi radialis-Sehnensuspension. Handchir Mikrochir Plast Chir 38:98–103. doi:10.1055/s-2006-924061

    Article  PubMed  CAS  Google Scholar 

  10. Daecke W, Streich N, Schneider S et al (2005) Stellenwert der Endoprothetik im Bereich der Handchirurgie Endoprothetik vs. traditionelle Operationsverfahren. Unfallchirurg 108:119–125. doi:10.1007/s00113-004-0867-y. Discussion 126

    Article  PubMed  CAS  Google Scholar 

  11. Tomaino MM (2001) Ligament reconstruction tendon interposition arthroplasty for basal joint arthritis. Rationale, current technique, and clinical outcome. Hand Clin 17:207–221

    PubMed  CAS  Google Scholar 

  12. Wolf JM, Delaronde S (2012) Current trends in nonoperative and operative treatment of trapeziometacarpal osteoarthritis: a survey of US hand surgeons. J Hand Surg Am 37:77–82. doi:10.1016/j.jhsa.2011.10.010

    Article  PubMed  Google Scholar 

  13. Demir E, Wittemann M, Germann G et al (2005) Treatment of idiopathic postmenopausal osteoarthrosis of the trapeziometacarpal joint with the Epping resection arthroplasty technique. Ann Plast Surg 54:147–152. doi:10.1097/01.sap.0000143607.46558.7a

    Article  PubMed  CAS  Google Scholar 

  14. Wittemann M, Demir E, Sauerbier M et al (2002) Die resektions-suspensions-arthroplastik nach Epping: ein derzeitiger standard in der operativen rhizarthrosen-behandlung? Handchir Mikrochir Plast Chir 34:49–58

    Article  PubMed  CAS  Google Scholar 

  15. Tomaino MM (2006) Suspensionplasty for basal joint arthritis: why and how. Hand Clin 22:171–175. doi:10.1016/j.hcl.2006.02.009

    Article  PubMed  Google Scholar 

  16. Fulton DB, Stern PJ (2001) Trapeziometacarpal arthrodesis in primary osteoarthritis: a minimum two-year follow-up study. J Hand Surg Am 26:109–114. doi:10.1053/jhsu.2001.20964

    Article  PubMed  CAS  Google Scholar 

  17. Spaans AJ, van Laarhoven CMCM, Schuurman AH et al (2011) Interobserver agreement of the Eaton–Littler classification system and treatment strategy of thumb carpometacarpal joint osteoarthritis. J Hand Surg Am 36:1467–1470

    Article  PubMed  CAS  Google Scholar 

  18. Gummesson C, Atroshi I, Ekdahl C (2003) The Disabilities of the Arm, Shoulder and Hand (DASH) outcome questionnaire: longitudinal construct validity and measuring self-rated health change after surgery. BMC Musculoskelet Disord 4:11. doi:10.1186/1471-2474-4-11

    Article  PubMed  Google Scholar 

  19. 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 55:56–57

    PubMed  CAS  Google Scholar 

  20. Epping W, Noack G (1983) Die operative Behandlung der Sattelgelenksarthrose. Handchir Mikrochir Plast Chir 15:168–176

    PubMed  CAS  Google Scholar 

  21. Burton RI, Pellegrini VD (1986) Surgical management of basal joint arthritis of the thumb. Part II. Ligament reconstruction with tendon interposition arthroplasty. J Hand Surg Am 11:324–332

    Article  PubMed  CAS  Google Scholar 

  22. Wajon A, Carr E, Edmunds I et al (2009) Surgery for thumb (trapeziometacarpal joint) osteoarthritis. Cochrane Database Syst Rev CD004631. doi:10.1002/14651858.CD004631.pub3

  23. Vermeulen GM, Brink SM, Sluiter J et al (2009) Ligament reconstruction arthroplasty for primary thumb carpometacarpal osteoarthritis (weilby technique): prospective cohort study. J Hand Surg Am 34:1393–1401. doi:10.1016/j.jhsa.2009.06.019

    Article  PubMed  CAS  Google Scholar 

  24. Kokkalis ZT, Zanaros G, Sotereanos DG (2009) Ligament reconstruction with tendon interposition using an acellular dermal allograft for thumb carpometacarpal arthritis. Tech Hand Up Extrem Surg 13:41–46. doi:10.1097/BTH.0b013e31818be857

    Article  PubMed  Google Scholar 

  25. Forthman CL (2009) Management of advanced trapeziometacarpal arthrosis. J Hand Surg Am 34:331–334. doi:10.1016/j.jhsa.2008.11.028

    Article  PubMed  Google Scholar 

  26. Brand J, Gaulke R, Geerling J et al (2007) Die Suspensionsarthroplastik am Daumensattelgelenk: Modifizierte Operationstechnik, Nachbehandlung und Ergebnisse—Eine retrospektive Analyse von 51 Operationen. Unfallchirurg 110:402–407. doi:10.1007/s00113-006-1224-0

    Article  PubMed  CAS  Google Scholar 

  27. Imaeda T, Cooney WP, Niebur GL et al (1996) Kinematics of the trapeziometacarpal joint: a biomechanical analysis comparing tendon interposition arthroplasty and total-joint arthroplasty. J Hand Surg Am 21:544–553. doi:10.1016/S0363-5023(96)80002-5

    Article  PubMed  CAS  Google Scholar 

  28. Megerle K, Grouls S, Germann G et al (2011) Revision surgery after trapeziometacarpal arthroplasty. Arch Orthop Trauma Surg 131:205–210. doi:10.1007/s00402-010-1128-x

    Article  PubMed  CAS  Google Scholar 

  29. Luria S, Waitayawinyu T, Nemechek N et al (2007) Biomechanic analysis of trapeziectomy, ligament reconstruction with tendon interposition, and tie-in trapezium implant arthroplasty for thumb carpometacarpal arthritis: a cadaver study. J Hand Surg Am 32:697–706. doi:10.1016/j.jhsa.2007.02.025

    Article  PubMed  Google Scholar 

  30. Sirotakova M, Figus A, Elliot D (2007) A new abductor pollicis longus suspension arthroplasty. J Hand Surg Am 32:12–22. doi:10.1016/j.jhsa.2006.10.016

    Article  PubMed  Google Scholar 

  31. Kriegs-Au G, Petje G, Fojtl E et al. (2004) Ligament reconstruction with or without tendon interposition to treat primary thumb carpometacarpal osteoarthritis. A prospective randomized study. J Bone Joint Surg Am 86-A: 209–218. doi:10.2106/JBJS.D.02630

  32. Belcher HJ, Nicholl JE (2000) A comparison of trapeziectomy with and without ligament reconstruction and tendon interposition. J Hand Surg Br 25:350–356. doi:10.1054/jhsb.2000.0431

    Article  PubMed  CAS  Google Scholar 

  33. Soejima O, Hanamura T, Kikuta T et al (2006) Suspensionplasty with the abductor pollicis longus tendon for osteoarthritis in the carpometacarpal joint of the thumb. J Hand Surg Am 31:425–428. doi:10.1016/j.jhsa.2005.12.010

    Article  PubMed  Google Scholar 

  34. Davis TRC, Pace A (2009) Trapeziectomy for trapeziometacarpal joint osteoarthritis: is ligament reconstruction and temporary stabilisation of the pseudarthrosis with a Kirschner wire important? J Hand Surg Eur 34:312–321. doi:10.1177/1753193408098483

    CAS  Google Scholar 

  35. Kochevar AJ, Adham CN, Adham MN et al (2011) Thumb basal joint arthroplasty using abductor pollicis longus tendon: an average 5.5-year follow-up. J Hand Surg Am 36:1326–1332. doi:10.1016/j.jhsa.2011.05.026

    Article  PubMed  Google Scholar 

  36. Gangopadhyay S, McKenna H, Burke FD et al (2012) Five- to 18-year follow-up for treatment of trapeziometacarpal osteoarthritis: a prospective comparison of excision, tendon interposition, and ligament reconstruction and tendon interposition. J Hand Surg Am 37:411–417. doi:10.1016/j.jhsa.2011.11.027

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Center of Plastic-, Hand- and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93042, Regensburg, Germany

    Silvan M. Klein, Gisela Breindl, Melanie Mielenz, Christina Roll & Lukas Prantl

  2. Department of Hand Surgery, Hospital Munich Perlach, Munich, Germany

    Gisela Breindl

  3. Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany

    Michael Koller

  4. Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany

    Bernd Kinner

Authors
  1. Silvan M. Klein
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gisela Breindl
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael Koller
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Melanie Mielenz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christina Roll
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Bernd Kinner
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Lukas Prantl
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Silvan M. Klein.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Klein, S.M., Breindl, G., Koller, M. et al. Midterm results after modified Epping procedure for trapeziometacarpal osteoarthritis. Arch Orthop Trauma Surg 133, 1163–1171 (2013). https://doi.org/10.1007/s00402-013-1776-8

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-013-1776-8

Keywords

Search

Navigation