Trapeziectomy and Ligament Reconstruction for Osteoarthrosis of the Base of the Thumb

Abstract

100 thumbs with primary osteoarthrosis of the joints of the trapezium were treated by trapeziectomy and a FCR sling arthroplasty to reconstruct a first intermetacarpal ligament by the method described by Burton and Pellegrini (1986). Pain at rest remained in five. Some pain at or after exertion persisted in 46, and 49 became completely pain-free. 88 were satisfied with the procedure and there was a significant increase in pinch strength and in the ability to perform activities of daily life. It has become our preferred procedure for treating osteoarthrosis of the basal joint of the thumb.

69 Ligament Reconstruction with Tendon Interposition

“…The technique described by Burton and Pellegrini combines total excision of the trapezium with reconstruction of the anterior capsule using a FCR tendon and applying interposition with the remaining end of the tendon. The outcomes of several series reporting on this procedure give good and excellent results with between 80 and 92% satisfied patients, even over the long term (2,(8)(9)(10)(11)(12)(13)15). This has been confirmed by our series.…”

Trapeziectomy for basal thumb joint osteoarthritis: 3- to 19-year follow-up

“…Dhar et al [5] with an average follow-up of 6 years after excision also reported 45% of patients with no pain. Nylen et al [8] had similar results in 100 trapeziectomies with tendon interposition and ligament reconstruction, with 88% of patients satisfied with their operation and 49% completely pain-free. Menon [10] recorded a higher rate of complete pain relief (83% of operated thumbs) after partial trapeziectomy with tendon interposition but the mean follow-up was only after 4 years.…”

“…Similar studies of excision with soft tissue interposition and ligament reconstruction have shown equally good results concerning pain relief and functional outcome [8][9][10] but are more technically demanding procedures. Excision and silastic interposition have also…”

“…Further papers have reported the results of simple excision of the trapezium [1,2,4,5], trapeziectomy with silastic interposition [6,7], and trapeziectomy with soft tissue interposition and ligament reconstruction [8,9]. Other surgical procedures for osteoarthritis of the trapeziometacarpal joint include partial trapeziectomy and interpositional arthroplasty (soft tissue [10], silastic, and titanium), arthrodesis of the trapeziometacarpal joint [11], and total joint replacement [12].…”

Rehabilitation Protocol after Suspension Arthroplasty of Thumb Carpometacarpal Joint Osteoarthritis

“…There was a 72% improvement in key pinch in the study by Nyl en et al 25 study after 36 months. Our results showed 25% and 29% improvements in postoperative period and at the end of 31.5 months follow-up, respectively compared with the preoperative values in lateral pinch measurements.…”