Outcomes of modified trapeziectomy with ligament reconstruction tendon interposition for the treatment of advanced thumb carpometacarpal arthritis

Abstract

Numerous arthroplasty techniques had been reported for the treatment of thumb carpometacarpal (CMC) joint osteoarthritis. The purpose of our study is to evaluate long-term clinical and radiographic outcomes of patients who underwent modified trapeziectomy with ligament reconstruction tendon interposition (LRTI).Our retrospective study included 20 consecutive patients with advanced thumb CMC arthritis receiving modified trapeziectomy with LRTI (20 thumbs). For clinical evaluation, we assessed visual analogue scale (VAS), Disabilities of the Arm, Shoulder and Hand (DASH) scores and Kapandji index. Additionally, the grip, pinch power and waist flexion power, radial and volar abduction angle were evaluated, As for radiologic evaluation, we just estimated height of the trapezial space.We took 2-year follow-up. All patients showed decreased VAS from 6.8 preoperatively to 1.4. Mean DASH and Kapandji scores were improved from 52.2 preoperatively to 21.6 and from 6.4 preoperatively to 7.4, respectively. Compared to preoperative range of motion (ROM) for radial abduction and volar abduction, both markedly increased at 2-year follow-up (from 61.2 to 80.1, from 60.6 to 78.3, respectively). Besides, mean power improved from 15.9 preoperatively to 21.7 kg at 2-year follow-up for grip power, from 1.9 preoperatively to 3.5 kg at 2-year follow-up for tip pinch; however, mean waist flexion power showed no significant change from 20.5 preoperatively to 19.7 kg at 2-year follow-up. Notably, there was no significant sinking in height of the trapezial space from 10.0 preoperatively to 9.6 mm at 2-year follow-up. NO case had a complication at final follow-up.Modified trapeziectomy with LRTI treating thumb CMC arthritis in Eaton stage III–IV had a satisfactory efficacy. This new procedure is able to provides enough support for thumb to prevents thumb sinking.

Joint Distraction for Thumb Carpometacarpal Osteoarthritis: 2-Year Follow-up Results of 20 Patients

“…No MHQ scores were assessed. 29 Although pain intensity improved more in their study, this can be related to the higher baseline intensity reported, since the results at 2 years are nearly the same (14 vs. 18). The improvement in MHQ of 22 points at 1 year is comparable to the results of a recent prospective cohort study among 233 Dutch patients who underwent trapeziectomy with interposition tendinoplasty: MHQ scores increased with 21 points to 69 points after 1 year.…”

“…The median improvements in DASH, MHQ, and VAS pain scores of 28, 21, and 35 at 1 year, respectively, and 31, 27, and 32 at 2 years are comparable to prior published outcomes after trapeziectomy (with or without interposition). [26][27][28][29] Wang et al retrospectively reviewed 20 patients who received trapeziectomy with LRTI and reported improvements of 30 points in DASH (from 52 to 22) and 54 in pain intensity (68 to 14) at 2-year follow-up. No MHQ scores were assessed.…”

Outcome of trapeziectomy with ligament reconstruction tendon interposition for the treatment of advanced thumb carpometacarpal arthritis: a prospective study

“…In a study by Wang et al 20 patients were included in their study. 9 The mean age in their study was 54.1 years old. In our study out of 30 patients 7 were males (23.33%) and 23 were females (76.67%).…”

Allogeneic Tendon Ball Tamponade With The Proximal Joint Surface Of Trapezium Preservation For Treatment Of The First Carpometacarpal Joint Arthritis: A Retrospective Study

“…Joint dislocation and collapse can easily occur after surgery. Some scholars have also proposed non-plugging therapies such as total trapezium excision with button plate suspension of the rst metacarpal bone 11 and autograft tendon transposition with joint ligament reconstruction 12 . However, the rst carpometacarpal joint would be in poor stability as its subsidence and dorsal intercalated segment instability (DISI) would appear as a disability of the distal portion of the scaphoid after total trapezium excision 13,14 .…”