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Interposition suspension arthroplasty according to Epping versus arthrodesis for trapeziometacarpal osteoarthritis

Interpositions- und Aufhängeplastik nach Epping versus Arthrodese für Trapeziometakarpalarthrose

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Zusammenfassung

GRUNDLAGEN: Sattelgelenkarthrodese und kombinierte Interpositionsaufhängeplastik nach Epping zeigen gute Ergebnisse in der Therapie der Rhizarthrose. Zur Bewertung der genannten Operationsverfahren haben wir die objektiven und subjektiven Resultate bei unseren Patienten erhoben und ausgewertet. METHODIK: In 37 randomisierten Patienten (40 Daumen) wurden entweder Sattelgelenkarthrodesen oder – arthroplastiken nach Epping vorgenommen. 20mal erfolgte die Arthrodese (Gruppe I), 20mal die Arthroplastik (Gruppe II). Die Nachbeobachtungszeit betrug 6 Monate und dann durchschnittlich 6,8 Jahre. Als Beurteilungskriterien wurden jene von Buck-Gramcko verwendet. ERGEBNISSE: Bessere durchschnittliche Resultate wurden in der Gruppe I 6 Monate nach der Operation gefunden. Die Ergebnisse in beiden Gruppen während den letzten klinischen Untersuchungen hatten aber keine signifikanten Unterschiede. Nur bezüglich der palmaren und radialen Abduktion ergaben sich in der Gruppe II bessere durchschnittliche Ergebnisse im Vergleich zur Gruppe I. Keine signifikante Unterschiede in anderen Kategorien wurden beobachtet. SCHLUSSFOLGERUNGEN: Die Nachbehandlung nach der Interpositionsaufhängeplastik dauert längere Zeit. Die Frühergebnisse sind deshalb besser nach der Arthrodese, während den späteren Untersuchungen wurden aber keine signifikanten Unterschiede beobachtet.

Summary

BACKGROUND: Arthrodesis and trapezial excision with ligament reconstruction combined with tendon interposition according to Epping have proven to be highly effective techniques for treating primary osteoarthritis of the thumb carpometacarpal joint. To determine which of these two techniques gives better objective and subjective outcomes, the long-term results were compared in similar patients' groups. METHODS: 40 thumbs were prospectively randomized to undergo either carpometacarpal arthrodesis or trapezial excision with ligament reconstruction combined with tendon interposition. 20 cases treated with arthrodesis (group I) and 20 cases treated with arthroplasty (group II) were evaluated 6 months after the operation and then after a mean follow-up of 6.8 years. The outcomes were assessed with the Buck-Gramcko score. RESULTS: 6 months postoperatively, the mean total Buck-Gramcko score was rated significantly better in group I than in group II. But at the last follow-up control, no significant difference was found between both groups. Only group II had significantly better mean scores for palmar abduction and radial abduction. Other mean objective and subjective scores did not differ significantly between the groups. CONCLUSIONS: The after-treatment in patients undergoing arthroplasty lasted longer than in patients after the arthrodesis. It is caused by more complex surgery during Epping's procedure. But the outcomes become similar over a longer period. At the final follow-up control after arthroplasty only older patients subjectively appreciated better functional performance. After this experience we reserve the arthrodesis for younger active and arthroplasty for older patients.

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References

  • Alberts KA, Engkvist O (1989) Arthrodesis of the first carpo-metacarpal joint: 33 cases of arthrosis. Acta Orthop Scand 60: 258–260

    Article  PubMed  CAS  Google Scholar 

  • Bamberger HB, Stern PJ, Kiefhaber TR, McDonough JJ, Cantor RM (1992) Trapeziometacarpal joint arthrodesis: a functional evaluation. J Hand Surg 17: 605–611

    CAS  Google Scholar 

  • Buck-Gramcko D (1994) Bewertung der Ergebnisse von Operationen wegen Daumensattelgelenksarthrose. Rundschreiben an die Teilnehmer der XII. Basler Handchirurgischen Arbeitstagung, März 1987. In: Buck-Gramcko D, Helbig B (Hrsg) Daumensattelgelenksarthrose. Stuttgart, Hippokrates, pp 43–44

    Google Scholar 

  • Burton RL, Pellegrini VD Jr (1986) Surgical management of basal joint arthritis of the thumb. J Hand Surg 11: 324–332

    CAS  Google Scholar 

  • de la Caffiniere JY (1974) Prothese totale trapézometacarpienne. Rev Chir Orthop 60: 299–308

    PubMed  CAS  Google Scholar 

  • Cavallazzi RM, Spreafico G (1986) Trapezio-metacarpal arthrodesis today: why? J Hand Surg 11: 250–254

    CAS  Google Scholar 

  • Cizmár I, Svízenská I, Mašek M, Bujok T, Ira D (2005) Partial denervation of the wrist by excision of the interosseous nerves from the dorsal approach. Acta Chir orthop Traum cech 72: 47–51

    PubMed  Google Scholar 

  • Conolly WB, Rath S (1993) Revision procedures for complications of surgery for osteoarthritis of the carpometacarpal joint of the thumb. J Hand Surg 18: 533–539

    CAS  Google Scholar 

  • Dell PC, Brushart TM, Smith RJ (1978) Treatment of trapeziometacarpal arthritis: results of resection arthroplasty. J Hand Surg 3: 243–249

    CAS  Google Scholar 

  • Eaton RG, Littler W (1973) Ligament reconstruction for the painful thumb carpometacarpal joint. J Bone Joint Surg 55: 1655–1666

    PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  • Froimson AI (1970) Tendon arthroplasty of the trapeziometacarpal joint. Clin Orthop 70: 191–199

    PubMed  CAS  Google Scholar 

  • Gervis WH (1949) Excision of the trapezium for osteoarthritis of the trapezio-metacarpal joint. J Bone Joint Surg (Br) 31: 537–539

    Google Scholar 

  • Hilty M, Stober R (1996) Results of basal joint arthrosis treatment with trapezectomy and Epping suspension-plasty. Clinical follow-up. Handchir Mikrochir Plast Chir 28: 15–21

    PubMed  CAS  Google Scholar 

  • Kaarela O, Raatikainen T (1999) Abductor pollicis longus tendon interposition arthroplasty for carpometacarpal osteoarthritis fo the thumb. J Hand Surg 24: 469–475

    Article  CAS  Google Scholar 

  • Krein R, Richter M, Bruser P (2001) Does Epping resection arthroplasty lead to a loss of hand strength? A prospective study. Handchir Mikrochir Plast Chir 33: 171–175

    Article  PubMed  CAS  Google Scholar 

  • Kvarnes L, Reikerås O (1985) Osteoarthritis of the carpometacarpal joint of the thumb. An analysis of operative procedures. J Hand Surg 10: 117–120

    CAS  Google Scholar 

  • Lutonský M (1998) Development and implantation of the Rubena CMC in rhisosteoarthritis). Acta Chir orthop Traum cech 65: 38–40

    PubMed  Google Scholar 

  • Lutonský M, Pellar D (2004) Results of Menon's arthroplasty in basal joint osteoarthritis. Acta Chir orthop Traumcech 71: 245–248

    Google Scholar 

  • Menon J (1995) Partial trapeziectomy and interpositional arthroplasty for trapeziometacarpal osteoarthritis of the thumb. J Hand Surg 20: 700–706

    CAS  Google Scholar 

  • Mentzel M, Ebinger T, Heckmann E, Merk SE, Kinzl L, Wachter NJ (2001) Results of basal joint arthrosis treatment – comparison of Epping ligament reconstruction with trapeziectomy alone. Handchir Mikrochir Plast Chir 33: 176–180

    Article  PubMed  CAS  Google Scholar 

  • Müller GM (1949) Arthrodesis of the trapezio-metacarpal joint for osteoarthritis. J Bone Joint Surg (Br) 31: 540–542

    Google Scholar 

  • Murley AHG (1960) Excision of the trapezium in osteoarthritis of the first carpometacarpal joint. J Bone Joint Surg (Br) 42: 502–507

    Google Scholar 

  • Necking LE, Eiken O (1986) ECRL-strip for metacarpal base fixation after axcision of the trapezium. Scand J Plast Reconstr Surg 20: 229–234

    PubMed  CAS  Google Scholar 

  • Swanson AB (1985) Arthroplasty of the thumb basal joints. Clin Orthop 195: 151–154

    PubMed  Google Scholar 

  • Swanson AB (1968) Silicone rubber implants for replacements of arthritis or destroyed joints in the hand. Surg Clin A Am 48: 1113–1127

    CAS  Google Scholar 

  • Weilby A (1988) Tendon interposition arthroplasty of the first carpo-metacarpal joint. J Hand Surg 13: 421–425

    CAS  Google Scholar 

  • Wilson JN (1973) Basal osteotomy of the first metacarpal in the treatment of arthritis of the carpo-metacarpal joint of the thumb. Br J Surg 60: 854–858

    PubMed  CAS  Google Scholar 

  • Wittemann M, Demir E, Sauerbier M, Germann G (2002) The Epping resection-suspension arthroplasty procedure. A standard procedure in the operative treatment of trapeziometacarpal osteoarthrosis? Handchir Mikrochir Plast Chir 34: 49–58

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedics, General Hospital Znojmo, Znojmo, Czech Republic

    R. Hart, V. Šiška, B. Kučera & V. Štipčák

  2. Trauma Center, Department of Traumatology, Masaryk's University, Brno, Czech Republic

    M. Janeček

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  1. R. Hart
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  2. M. Janeček
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  3. V. Šiška
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  4. B. Kučera
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  5. V. Štipčák
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Correspondence to R. Hart.

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Hart, R., Janeček, M., Šiška, V. et al. Interposition suspension arthroplasty according to Epping versus arthrodesis for trapeziometacarpal osteoarthritis. Eur Surg 38, 433–438 (2006). https://doi.org/10.1007/s10353-006-0285-1

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  • DOI: https://doi.org/10.1007/s10353-006-0285-1

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