The Effect of Surgical Treatments for Trapeziometacarpal Osteoarthritis on Wrist Biomechanics: A Cadaver Study

Abstract

Purpose Studies have shown the effects of surgical treatments for trapeziometacarpal osteoarthritis on thumb biomechanics; however, the biomechanical effects on the wrist have not been reported. This study aimed to quantify alterations in wrist muscle forces following trapeziectomy with or without ligament reconstruction and replacement.Methods A validated physiological wrist simulator replicated cyclic wrist motions in cadaveric specimens by applying tensile loads to 6 muscles. Muscle forces required to move the intact wrist were compared with those required after performing trapeziectomy, suture suspension arthroplasty, prosthetic replacement, and ligament reconstruction with tendon interposition (LRTI).Results Trapeziectomy required higher abductor pollicis longus forces in flexion and higher flexor carpi radialis forces coupled with lower extensor carpi ulnaris forces in radial deviation. Of the 3 surgical reconstructions tested post-trapeziectomy, wrist muscle forces following LRTI were closest to those observed in the intact case throughout the range of all simulated motions. ConclusionsThis study shows that wrist biomechanics were significantly altered following trapeziectomy, and of the reconstructions tested, LRTI most closely resembled the intact biomechanics in this cadaveric model. Clinical relevance Trapeziectomy, as a standalone procedure in the treatment of trapeziometacarpal osteoarthritis, may result in the formation of a potentially unfilled trapezial gap, leading to higher wrist muscle forces. This biomechanical alteration could be associated with clinically important outcomes, such as pain and/or joint instability.

Ultrasound visualization of the thumb annular pulleys: A cadaveric validation study

“…First, although the use of a cadaveric model may be considered a study limitation, anatomic dissections were necessary to validate the US findings. We believe the sample size of 12 cadaveric models is adequate as (1) our sample allowed for observation of previously documented variability in thumb pulleys and (2) the number of specimens used is commensurate with previously published manuscripts 22‐24 . It should be noted that all the cadaveric specimens were male with a limited age range (78–89 years old).…”

“…We believe the sample size of 12 cadaveric models is adequate as (1) our sample allowed for observation of previously documented variability in thumb pulleys and (2) the number of specimens used is commensurate with previously published manuscripts. [22][23][24] It should be noted that all the cadaveric specimens were male with a limited age range (78-89 years old). The configuration of the thumb pulley system would not be expected to differ significantly based on age or gender, analogous to the pulley system of the fingers in which there are no major differences between genders.…”

Trapezial dysplasia and concomitant disorders around the thumb can influence the outcome after total carpometacarpal joint replacement: Report of two cases, short review of literature, and update to the Arpe™ prosthesis

“…Compared to trapeziectomy as unchanged the most widely performed procedure worldwide, the rationale behind total CMCJ I replacement is that this procedure obtains normal length of the thumb associated with normal muscle forces resulting in a higher carpometacarpal and metacarpaophalangeal joint stability, no occurrence of painful impingement between the base of the first metacarpal bone and the scaphoid and/or trapezoid bone, and normal tendon loads in order to achieve a certain key pinch force [47][48][49][50][51]. Noted that total CMCJ I replacement is not generally to be considered as contraindication for patients with high claims in occupational work and leisure [52,53].…”

Carpometacarpal osteoarthritis of the thumb associated with uncommon concomitant hypoproteinemia mimicking irreversible carpal tunnel syndrome: Case report

“…When decreased, forces of the donor muscle-tendon unit should be preserved [11]. The problem of trapeziectomy is that this procedure does not obtain normal length of the thumb potentially leading to a painful impingement between the base of the first metacarpal and scaphoid or trapezoid bone (Figure 4A) associated with non-physiological muscle and tendon forces often resulting in a decreased stability in the adjacent metacarpaophalangeal joint, impaired grip strength and key pinch forces as compared to a total CMCJ I replacement [15][16][17][18][19][20]. Therefore, the CMCJ I arthrodesis was the only option of choice in order to improve the functionality of the entire affected hand with our patient.…”