Weilby tendon interposition arthroplasty for osteoarthritis of the trapezial joints

Abstract

Primary osteoarthritis of the trapezial joints has been treated by an interposition tendoplasty according to Weilby in eighty-nine cases. After excision of the trapezium, a strip from the flexor carpi radialis was wound around the main portion of the flexor carpi radialis tendon and the abductor pollicis longus. The abductor tendon was then duplicated over the tendoplasty and reinserted to the first metacarpal base. In 40% of cases, osteoarthritis was present in more than one trapezial joint. 57% had an adduction contracture of the first metacarpal, half of which were relieved postoperatively. 73% of patients were satisfied at follow-up. Complications included four cases with loss of active metacarpal abduction which was regained after reinsertion of the abductor pollicis longus. It is concluded that the Weilby tendoplasty is a useful alternative to Silastic implants, especially in cases of adduction contracture. The risks of implant dislocation and silicone synovitis are eliminated.

Ligament Reconstruction Arthroplasty for Primary Thumb Carpometacarpal Osteoarthritis (Weilby Technique): Prospective Cohort Study

“…In our study, one patient had impaired hand function at the 12-month follow-up caused by radiocarpal degenerative changes. Our complication rates compare favorably with the earlier study of Nylen et al 17 (Weilby procedure). They reported 15 complications of surgery in 89 arthroplasties (5 patients had reflex sympathetic dystrophy, 2 patients had transient edema, 1 patient had trigger thumb, 3 patients had carpal tunnel compression, and 4 patients had loss of first metacarpal abduction).…”

“…In 1988, Weilby 16 reported outcomes of the first 100 operated thumbs, of which 85% had complete pain relief. In 1987, Nylen et al 17 reported similar results with this technique. These now 20-year-old studies of the Weilby procedure are retrospective studies, and they do not include preoperative and postoperative subjective outcomes using validated questionnaires or preoperative and postoperative objective outcomes such as specific strength and rangeof-motion (ROM) measurements.…”

“…The results in the study of Nylen et al. 17 included overall satisfaction, pain relief, and return-to-work and complication rates. The results in the study of Weilby 16 included pain relief, ROM, and strength measurements compared with those of the contralateral thumb and complication rates.…”

“…Our results also showed that 90% of our patients were satisfied with the procedure (90% would have the surgery again; 90% had an improved pain level; 90% rated their overall satisfaction as excellent, good, or acceptable). Nylen et al 17 reported that only 73% of their patients were satisfied with the Weilby procedure; 27% were not. Our patient-satisfaction rating of 90% compares favorably with that of Nylen et al 17 and is in line with those reported by randomized controlled studies of the more commonly performed Burton-Pelligrini technique (De Smet et al 24 reported 90% patient satisfaction; Kriegs-Au et al 13 reported 85%).…”

“…They reported 15 complications of surgery in 89 arthroplasties (5 patients had reflex sympathetic dystrophy, 2 patients had transient edema, 1 patient had trigger thumb, 3 patients had carpal tunnel compression, and 4 patients had loss of first metacarpal abduction). 17 Weilby 16 reported that 7% of his patients developed de Quervain's disorder and suggested that a routine release of the first extensor compartment during the procedure could prevent de Quervain's disorder. We do not recommend this because we observed only one episode of de Quervain's disorder after 12 months of follow-up, and it responded very well to an injection of steroids.…”