Excision of the Trapezium and Interposition Arthroplasty with Gelfoam for the Treatment of Trapeziometacarpal Osteoarthritis

Abstract

Excision of the trapezium with Gelfoam interposition was performed in 35 thumbs, 34 of which were evaluated after an average 5 years. Twenty-four patients had unilateral procedures. The follow-up examination included a standardized questionnaire and clinical and radiological examinations. Pain relief was achieved in all cases. The patients considered that 32 of their operated hands had improved function, while two had not improved. All patients were satisfied with the final postoperative result. Adduction of the thumb to the index finger, and opposition to the tip of the little finger was possible in all cases. Weakness, in comparison to the other thumb, of lateral pinch (71%; P=0.0001), tip pinch (74%; P=0.007), and grip strength (85%; P=0.006) were observed. The first web span was preserved in all hands. Calculation of the trapezial space ratio demonstrated only slight, insignificant shortening (7%; P=0.06) of the thumb ray. No significant correlations between the postoperative trapezial space ratio and lateral pinch strength, tip pinch strength, and grip strength were observed. We conclude that excision of the trapezium and Gelfoam interposition has no specific complications and is a reliable surgical treatment for osteoarthritis of the trapeziometacarpal joint.

Update on Nonautogenous Interposition Arthroplasty for Thumb Basilar Joint Arthritis

“…7 A more recent study in the literature reported success with Gelfoam. 8 The authors reported no specific complications, good results, and patient satisfaction.…”

An Evidence-Based Approach to Treating Thumb Carpometacarpal Joint Arthritis

“…Nusem reported a series 34 operations in which Gelfoam was used to fill the trapeziectomy space, which was stabilized with K-wires postoperatively (Level IV Evidence) 14. At 5 years, 68% of patients were pain-free, with reasonable strength (Table 4).…”

“…DeSmet was able to demonstrate a weak association between scaphometacarpal space and key pinch, but this finding is difficult to interpret, as it came from a study in which a statistically significant difference in key pinch could not be detected between the T and T+LRTI groups (Level II Evidence) 18. Many other studies have failed to find any association between scaphometacarpal space and strength,4, 9, 14–16 pain relief,4, 12 or function15, 16 (Level II, IV Evidence) .…”

Thumb Carpometacarpal Arthritis

“…The space created by the trapeziectomy can be replaced with tendon interposition to prevent metacarpal subsidence. 26 Other materials such as hematoma 27,28 and gel foam 29 have been used to maintain the space. Trapeziectomy can also be combined with ligament reconstruction tendon interposition.…”