Effect of Trapeziectomy on Carpal Stability

Abstract

Background: The scaphoid-trapezoid-trapezium (STT) articulation stabilizes the scaphoid and links the proximal and distal carpal rows. The purpose of the study was to determine whether trapezium excision in the treatment of trapeziometacarpal (TM) arthritis affects carpal stability. Methods: A retrospective chart and radiographic review was performed on all wrists that underwent trapeziectomy with suspensionplasty or ligament reconstruction, and tendon interposition for TM arthritis between 2004 and 2016. Radiographic outcome measures included the modified carpal height ratio (MCHR) and radioscaphoid (RS), radiolunate (RL), and scapholunate (SL) angles. Degenerative change at the TM and STT joints was classified according to the Eaton-Littler, and Knirk and Jupiter classification systems. Radiographic parameters were compared between preoperative and final follow-up time points. Results: A total of 122 wrists were included in the study with a mean follow-up of 3.5 years (range: 1.0-13.0 years). The mean RL (range: −2.2° ± 11.8° to −10.7° ± 16.5°) and RS angles (range: 52.6° ± 13.8° to 44.4° ± 17.8°) decreased significantly (<.001) without significant change in SL angle, indicating progressive lunate and scaphoid extension after trapeziectomy. The mean MCHR decreased significantly (range: 1.6 ± 0.1 to 1.5 ± 0.1) following trapeziectomy, indicating progressive carpal collapse. Progressive scaphoid-trapezoid arthrosis was observed following trapeziectomy. No other preoperative radiographic factors investigated were associated with significant differences in preoperative and postoperative values for radiographic outcome measures. Conclusions: Trapeziectomy can lead to loss of carpal height, coordinated extension of both the lunate and scaphoid, and progressive scaphotrapezoid arthrosis. As such, in wrists with dynamic or static carpal instability, trapeziectomy should be performed with caution due to the risk of carpal collapse with a nondissociative pattern of dorsal intercalated segment instability.

Trapeziectomy for basal thumb osteoarthritis does not increase the risk of developing wrist osteoarthritis in the long term

“…In contrast, a study that reviewed radiographs from 22 patients before and at mean of 8.5 months after trapeziectomy/LRTI reported a significant increase in number of wrists with abnormal scapholunate angle from 32% before to 55% after surgery [ 6 ]. In a study of 122 wrists examined before and at a mean of 3.5 (1–13) years after trapeziectomy/LRTI, the authors suggested increased risk of developing non-dissociative carpal instability patterns after trapeziectomy [ 4 ]. In a previous report of two cases of carpal collapse after trapeziectomy and partial trapezoid resection, the authors suggested that carpal collapse may more likely occur after trapeziectomy with simultaneous partial trapezoidectomy than after trapeziectomy alone [ 5 ].…”

“…In the United States, trapeziectomy with LRTI is one of the most common procedures used for treating TMC OA [ 2 ]. Trapeziectomy partly disrupts the constrains of the scaphotrapeziotrapeziod (STT) joint, which has been suggested to potentially cause a carpal instability pattern that has been termed as non-dissociative [ 4 – 6 ]. Non-dissociative carpal instability is defined as a kinematic dysfunction of the entire proximal carpal row, manifested as either an instability between the proximal and distal rows, or between the proximal row and the radius [ 7 ].…”

Total joint replacement for osteoarthritis of the carpometacarpal joint of the thumb: why and how?

“…Although there is no consensus on the impact of resection of the trapezium on carpal stability ( 17 , 18 ), recent publications concluded that trapeziectomy can lead to a loss of carpal height with extension of both the lunate and scaphoid and a non-dissociative pattern of dorsal intercalated segment instability (DISI) ( 19 , 20 ). This explains why patients with preoperative DISI deformity of the carpus have a significantly higher chance to be dissatisfied after trapeziectomy than patients without preoperative DISI ( 21 ).…”

“…Removal of the trapezium can lead to progressive arthrosis in the remaining articulation between the scaphoid and the trapezoid ( 19 , 20 , 21 ).…”

Our Treatment Strategy for CMC-1 Osteoarthritis

“…Studies have shown that trapeziectomy can lead to midcarpal instability and a loss of carpal height. [5,6] When a trapeziectomy is performed in patients with a preopera tive DISI deformity there is a higher chance of dissatisfaction [7] whereas a total joint arthroplasty will preserve the trapezium with out further destabilization of the wrist.…”