Carpometacarpal arthritis of the thumb

Damen, A.; Lei, van der Berend; Robinson, P. H.

doi:10.1016/s0363-5023(96)80196-1

Cited by 31 publications

(14 citation statements)

References 16 publications

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“…Many other operations provide satisfactory pain relief but all have certain disadvantages. Simple trapeziectomy is effective, [16][17][18][19][20][21][22][23][24][25][26] [28][29][30] Trapeziometacarpal arthrodesis provides a stable thumb, but reduces manual dexterity. [31][32][33] It requires prolonged immobilisation, the average rate of nonunion is 13%, 34 and pain may recur because of degenerative changes in the overloaded scaphotrapezial joint.…”

Section: Discussionmentioning

confidence: 99%

First metacarpal osteotomy for trapeziometacarpal osteoarthritis

Hobby

Lyall

Meggitt

1998

The Journal of Bone and Joint Surgery. British volume

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We report a long-term follow-up of abduction-extension osteotomy of the first metacarpal, performed for painful trapeziometacarpal osteoarthritis. Of a consecutive series of 50 operations, 41 thumbs (82%) were reviewed at a mean follow-up of 6.8 years. Good or excellent pain relief was achieved in 80%, and 93% considered that surgery had improved hand function, while 82% had normal grip and pinch strength, with restoration of thumb abduction. Trapeziometacarpal osteoarthritis is associated with degeneration of the palmar beak ligament 10 and articular degeneration starts on the joint surfaces adjacent to it. The cartilage of the dorsoradial joint surface is spared until late in the disease process. 10 A recent cadaver study has shown that extension osteotomy of the first metacarpal shifts the area of joint contact from the worn palmar cartilage to the normal dorsal surface. 11 We describe our experience of osteotomy in a large series of patients over a period of 12 years. Patients and MethodsWe carried out 50 operations in 42 patients; 41 thumbs (82%) in 33 patients were available for review at a mean of 6.8 years (2 to 12) from operation. The average age at operation was 57 years (20 to 73). Nine of the operations were in men and 32 in women, and the dominant hand was involved in 20 patients. Nine patients were lost to followup. Three had died, one had moved and could not be contacted, and three very elderly patients could not be traced. Another elderly man was too confused to co-operate. One patient was contacted by telephone but did not wish to be reviewed. When last seen she had complete relief of pain, full abduction and a strong grip. The patients were reviewed by a surgeon who had not been involved in the operation. Pain and hand function were assessed by the patient, using a self-administered questionnaire. Grip strength was measured with a Jamar dynamometer (Asimov Engineering Company, Los Angeles, California), and pulp to pulp (pinch) and lateral pinch (key-grip) with a B & L hydraulic pinch meter (B&L Engineering, Santa Fe Springs, California). The mean of three readings was compared with normal ranges matched for age and sex. 12 The range of movement and maximum abduction were measured clinically with a goniometer. Thumb opposition and the ability to flatten the palm were assessed and recorded. Indications for operation. Surgery was carried out when pain which interfered with everyday activities had not responded to conservative treatment with a splint, nonsteroidal anti-inflammatory drugs or injection with lignocaine and hydrocortisone. Osteotomy was only considered for mild and moderate degenerative changes confined to the trapeziometacarpal joint, scaphotrapezial wear being a contraindication. The preoperative radiographs were graded as described by Eaton and Littler 13 : grade 1, no radiological changes; grade 2, osteophytes or intra-articular fragments of <2 mm with no narrowing of

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Section: Discussionmentioning

confidence: 99%

First metacarpal osteotomy for trapeziometacarpal osteoarthritis

Hobby

Lyall

Meggitt

1998

The Journal of Bone and Joint Surgery. British volume

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“…There are multiple reports in the literature on the mid-and long-term results of RIAP, but most of them used examiner-dependent outcome measures and only a few of them employed standardized, valid, and comprehensive assessment instruments (11)(12)(13)(14). Hardly any study has examined the comparability of the various instruments used in relation to their relative validity, clinical utility, or specificity, especially among condition-specific tools.…”

Section: Introductionmentioning

confidence: 99%

Comprehensive assessment of clinical outcome and quality of life after resection interposition arthroplasty of the thumb saddle joint

Angst¹,

John²,

Goldhahn³

et al. 2005

Arthritis & Rheumatism

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“…Twenty-two of the 26 patients in whom surgery was uneventful (0.85) could touch the base of the small finger, and this compares with the 67% to 96% reported in other studies [23,33]. Pain relief after surgery was observed in 22 out of the 26 patients (0.85), which compares with the 67% to 92% reported after tendon interposition arthroplasty [3,7,16,31,35]. The patients in our series who had previously undergone surgery for CMC-I arthritis, in particular, continued to experience pain and difficulties with daily life activities.…”

Section: Discussionmentioning

confidence: 62%

Poor results after interpositional arthroplasty with fascia lata allograft for arthritis of the trapezio-metacarpal joint

Veen

Strackee

Karim³

et al. 2007

Eur J Plast Surg

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Arthrodesis or autologous tendon interposition can relieve pain associated with arthritis of the carpometacarpal joint of the first ray (CMC-I), but has its limitations. The aim of this study was to assess whether trapezium resection and fascia lata allograft (Tutoplast) interposition is a good alternative. Thirty-eight such combined CMC-I arthroplasties in 36 patients with a median age of 57 years and a median follow-up of 25 months were analysed for complications; Disabilities of Arm, Shoulder, and Hand questionnaire (DASH) scores; pain; and patient satisfaction. Complications occurred in 13 of the 36 patients (36%). The median DASH score was 25, and pain was reduced in 22 patients (85%). Thirteen of the 36 patients (36%) were not satisfied. Trapezium resection and fascia lata allograft interposition do not seem to be good alternatives for CMC-I arthritis.

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Carpometacarpal arthritis of the thumb

Cited by 31 publications

References 16 publications

First metacarpal osteotomy for trapeziometacarpal osteoarthritis

First metacarpal osteotomy for trapeziometacarpal osteoarthritis

Comprehensive assessment of clinical outcome and quality of life after resection interposition arthroplasty of the thumb saddle joint

Poor results after interpositional arthroplasty with fascia lata allograft for arthritis of the trapezio-metacarpal joint

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