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Theyskens NC, Vandesande W. Dislocation in Single-Mobility Versus Dual-Mobility Trapezometacarpal Joint Prostheses. Hand (N Y) 2024; 19:426-432. [PMID: 36214288 PMCID: PMC11067852 DOI: 10.1177/15589447221124257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND The purpose of this study was to analyze postoperative dislocation rates in single-mobility (Ivory) versus dual-mobility (Moovis) trapezometacarpal (TMC) joint prostheses. Second, we report complications requiring additional surgery in these 2 types of prostheses. METHODS We retrospectively obtained data of all patients receiving a TMC joint prothesis at our hospital between January 2015 and December 2020. We recorded the type of implant used (ie, single vs dual mobility; Ivory vs Moovis), and recorded dislocations and complications requiring additional surgery. RESULTS We recorded significantly more prosthetic dislocations in the single-mobility (Ivory) group (n = 6, 9.7%), compared with the dual-mobility (Moovis) group (n = 1, 1.4%). The most frequent complication requiring additional surgery was De Quervain tendinitis (n = 13, 9.6%). CONCLUSIONS This study shows that a dual-mobility TMC prosthesis has significantly less postoperative dislocations compared with its single-mobility counterpart. We identity De Quervain tendinitis as the most frequent complication requiring additional surgery.
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2
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Ruff LR, Delgadillo BE, El-Bahri GF. Management of a Traumatic Collapse of the First Carpometacarpal Joint After Trapeziectomy With Suture Suspensionplasty: A Case Report. Cureus 2024; 16:e60216. [PMID: 38868291 PMCID: PMC11167584 DOI: 10.7759/cureus.60216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 05/13/2024] [Indexed: 06/14/2024] Open
Abstract
Arthritis of the first carpometacarpal (CMC) joint is a common pathology hand surgeons encounter. Treatment begins with conservative measures, but when they fail, surgery is a viable option for providing relief to patients. The most widely used surgical technique is CMC arthroplasty with ligament reconstruction and tendon interposition (LRTI). However, more novel techniques such as trapeziectomy with suspensionplasty are gaining popularity. When surgical measures fail, it is important to identify the mechanism of failure and proper treatment options. There are multiple options for revision surgery at the surgeon's disposal, with no consensus on a superior technique. This case illustrates a patient with painful subsidence secondary to a traumatic collapse of the first CMC joint eight months status post suspensionplasty with trapeziectomy. After conservative measures failed to provide relief, it was decided that a surgical revision was appropriate. The surgeon chose to move forward with suture button suspensionplasty, as it has multiple advantages over LRTI. In the short-term follow-up after revision, the patient experienced improvements in pain and range of motion, along with radiographic evidence of proper alignment of the first metacarpal without subsidence. Regarding the treatment of a case such as this, the authors believe this case should serve as a reference that may be used by future physicians when deciding which surgical technique to employ for the revision of a traumatically collapsed first CMC joint after trapeziectomy with CMC joint suspensionplasty.
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Affiliation(s)
- Landan R Ruff
- Orthopedic Surgery, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Blake E Delgadillo
- Orthopedic Surgery, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - George F El-Bahri
- Orthopedic Surgery, Bahri Orthopedics and Sports Medicine Clinic, Jacksonville, USA
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3
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Lachnish J, Titan AL, Sen S, Yao J. Long-Term Results of Suture-Button Suspensionplasty in the Treatment of Thumb Carpometacarpal Arthritis: A Minimum 10-Year Follow-Up. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2024; 6:206-211. [PMID: 38903836 PMCID: PMC11185894 DOI: 10.1016/j.jhsg.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 12/13/2023] [Indexed: 06/22/2024] Open
Abstract
Purpose Combined trapeziectomy and suture-button suspensionplasty (SBS) is a common and well-established surgical treatment for thumb carpometacarpal (CMC) osteoarthritis. Although short and mid-term follow-up studies have shown promising outcomes with patients retaining excellent range of motion and strength, long-term data are lacking. The aim of our study was to assess the long-term outcomes of patients who underwent SBS surgery for thumb CMC arthritis, with a minimum follow-up period of 10 years. Methods We evaluated 17 patients, at least 10 years after undergoing SBS surgery for thumb CMC arthritis. We measured grip and pinch strength, range of motion, and trapezial space height and compared it with the respective values measured on the routine postoperative 3-month follow-up visit. All patients have additionally completed the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire. Results The study included 11 women and 6 men with an average age of 60.3 ± 6.4 years and a mean follow-up of 137.4 ± 11.4 months after surgery. The mean Quick Disabilities of the Arm, Shoulder, and Hand score was 9 (range: 0-40.9) at the long-term follow-up, compared with 26.2 (range: 4.5-75) recorded 3 months after the surgery. Grip and pinch strengths were 116% and 111% of the 3-month postoperative value, respectively. Radial abduction and palmar abduction were 98% and 94% of the 3-month postoperative value, respectively. Kapandji scores were either equal or higher than the previously documented scores. Average height of the trapezial space was 69% of the previous postoperative measurement. Conclusions Our findings demonstrate that patients who underwent SBS surgery for thumb CMC osteoarthritis achieve excellent long-term outcomes by maintaining favorable subjective and objective results, despite some radiographic subsidence over time. These results indicate SBS to be an effective and durable technique for the long-term management of thumb CMC osteoarthritis. Type of study/level of evidence Therapeutic IV.
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Affiliation(s)
- Jordan Lachnish
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA
| | - Ashley L. Titan
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA
| | - Subhro Sen
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA
| | - Jeffrey Yao
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA
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4
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Herren DB. Basal thumb arthritis surgery: complications and its management. J Hand Surg Eur Vol 2024; 49:188-200. [PMID: 38315137 DOI: 10.1177/17531934231197787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
The management of complications after surgery for basal thumb arthritis is sometimes challenging, and there are no clear recommendations on how to evaluate and manage patients with residual symptoms. The aim of the present article was to review the most common complications after surgery for basal thumb arthritis, with an emphasis on resection arthroplasty, joint replacement and joint fusion. In addition, possible management strategies for the different types of complications will be highlighted.
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Affiliation(s)
- Daniel B Herren
- Schulthess Klinik, Department of Hand Surgery, Zurich, Switzerland
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5
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Mahmood B, Hammert WC. Carpometacarpal Joint Pathology in the Thumb and Hand: Evaluation and Management of Difficult Conditions. Hand Clin 2023; 39:321-329. [PMID: 37453760 DOI: 10.1016/j.hcl.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Thumb carpometacarpal arthroplasty with complete trapeziectomy with or without suspensionplasty, ligament reconstruction, and/or tendon interposition is largely considered equivalent techniques in providing pain relief and improving function for patients with thumb carpometacarpal arthritis. In cases of continued pain, instability, and dysfunction following an index surgery, one must first identify the cause of failure. Any options for revision surgery depend on addressing the specific cause of persistent symptoms with awareness of available options. Most of the patients undergoing revision surgeries can achieve good to fair outcomes.
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Affiliation(s)
- Bilal Mahmood
- Department of Orthopaedic Surgery, University of Rochester, 601 Elmwood Avenue, Box 665, Rochester, NY 14642, USA
| | - Warren C Hammert
- Department of Orthopaedic Surgery, Duke University Medical Center, 5601 Arringdon Park Drive, Suite 300, Morrisville, NC 27560, USA.
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6
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Klim SM, Glehr R, Graef A, Amerstorfer F, Leithner A, Glehr M. Total joint arthroplasty versus resection-interposition arthroplasty for thumb carpometacarpal arthritis: a randomized controlled trial. Acta Orthop 2023; 94:224-229. [PMID: 37140370 PMCID: PMC10158789 DOI: 10.2340/17453674.2023.11919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND AND PURPOSE Thumb carpometacarpal (TCMC) osteoarthritis is a common condition that causes pain and functional limitations. We compared the outcomes of 2 surgical procedures for TCMC osteoarthritis, the Epping resection-suspension arthroplasty and the double-mobility TCMC prosthesis, and focused on pain relief, functional outcomes, and patient quality of life. PATIENTS AND METHODS Over a 7-year period a randomized controlled trial including 183 cases of TCMC osteoarthritis was conducted comparing a double mobility TCMC prosthesis (Moovis, Stryker, Kalamazoo, MI, USA) with the Epping resection-suspension arthroplasty. Pre- and postoperative examinations included the range of motion (ROM), SFMcGill score, visual analogue scale (VAS), the disabilities of the arm, shoulder and hand questionnaire (DASH), and the hospital anxiety and depression scale (HADS). RESULTS At the 6-week postoperative follow-up, significant differences were found in VAS: Epping median 4.0 (interquartile range [IQR] 2.0-5.0) vs. TCMC prosthesis 2.0 (IQR 0.25-4.0), p = 0.03, effect size (area under the curve [AUC]) 0.64 (95% confidence interval [CI] 0.55-0.73), in DASH score: Epping 61 (IQR 43-75) vs. TCMC prosthesis 45 (IQR 29-57), p < 0.001, AUC 0.69 (CI 0.61- 0.78), and in radial abduction: Epping 55 (IQR 50-60) vs. TCMC prosthesis 62 (IQR 60-70), p = 0.001, AUC 0.70 (CI 0.61-0.79). No significant group differences were found at the 6- and 12-months follow-up. During the follow-up period, 3 of 82 prostheses had to be revised but there was no revision in the Epping group. CONCLUSION The double mobility TCMC prosthesis had superior outcomes compared with the Epping procedure at 6 weeks; however, there were no significant differences in outcomes at 6 months and 1 year postoperatively. The implant survival rate of 96% after 12 months was acceptable.
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Affiliation(s)
- Sebastian M Klim
- Department for Orthopaedics and Trauma, Medical University of Graz, Graz.
| | - Reingard Glehr
- Institute of General Practice and Evidencebased Health Services Research, Medical University of Graz, Austria
| | - Armin Graef
- Department for Orthopaedics and Trauma, Medical University of Graz, Graz
| | | | - Andreas Leithner
- Department for Orthopaedics and Trauma, Medical University of Graz, Graz
| | - Mathias Glehr
- Department for Orthopaedics and Trauma, Medical University of Graz, Graz
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7
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Paterno AV, Lorbeer K, Patterson JMM, Draeger RW. Routine Postoperative Radiographs Do Not Affect Decision Making Following Carpometacarpal Arthroplasty. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023. [DOI: 10.1016/j.jhsg.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
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8
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Natural History of Metacarpal Subsidence following Trapeziectomy and Its Relationship to Clinical Outcomes. Plast Reconstr Surg 2023; 151:432e-440e. [PMID: 36730472 DOI: 10.1097/prs.0000000000009921] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
METHODS An institutional review board-approved retrospective review of patients who underwent trapeziectomy and ligament reconstruction and tendon interposition (LRTI) was conducted. Patient demographics, visual analogue scale pain scores, grip strength, pinch strengths, and radial and palmar abduction were collected. The trapezial space ratio (TSR) was measured by the scaphometacarpal distance divided by the length of the capitate. Subsidence [(postoperative TSR - preoperative TSR)/preoperative TSR] was measured and classified as severe (≥70%) or mild to moderate (<70%). Median rate of subsidence increase was calculated. Conolly-Rath scores were used to evaluate the proportion of good outcomes in each group. RESULTS A total of 141 trapeziectomies with LRTI were included. Subsidence increased 6.7% (5.4% to 23.0%) per week before 16 weeks and 0.3% (0.1% to 0.8%) per week thereafter. Visual analogue scale pain scores were not significantly different between patients with severe or mild to moderate subsidence ( P = 0.25) 16 weeks after thumb mobilization. The proportion of good outcomes was comparable between the two groups ( P = 0.12). There was no correlation between subsidence and pain (ρ = -0.20; P = 0.24), grip (ρ = -0.02; P = 0.93), key (ρ = -0.13; P = 0.62), tripod (ρ = 0.16; P = 0.71), or index tip pinch strengths (ρ = -0.28; P = 0.43) or radial (ρ = -0.03; P = 0.92) or palmar (ρ = -0.15; P = 0.61) abduction. CONCLUSIONS Subsidence occurs in all patients after trapeziectomy and LRTI, stabilizing 16 weeks after mobilization. Degree of subsidence does not correlate with postoperative outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, II.
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9
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Taleghani ER, Moran TE, Ignozzi A, Chhabra AB, Freilich A. Arthrodesis of the First to Second Metacarpal for Definitive Management of Failed Thumb Carpometacarpal Arthroplasty: A Case Series. Tech Hand Up Extrem Surg 2023; 27:22-29. [PMID: 35975927 DOI: 10.1097/bth.0000000000000405] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Thumb carpometacarpal (CMC) arthroplasty with resection of the trapezium and soft tissue interposition, with or without ligament reconstruction, has historically proven to be an efficacious treatment for thumb CMC arthritis. The incidence of failure following primary thumb CMC arthroplasty is low; however, the evaluation and management of a patient experiencing an unsatisfactory outcome following CMC arthroplasty is challenging. If symptoms are refractory to conservative measures, then revision surgical treatment may be indicated. Clinical decision making becomes even more complicated in cases of failure after an initial revision surgery has already been performed. In patients with a failed CMC arthroplasty revision in whom all soft tissue options have been exhausted, the senior author considers arthrodesis of the first metacarpal base to the second metacarpal base as a salvage procedure. The authors describe this surgical technique and present our experience with 4 cases in 3 patients who underwent this surgical intervention. Successful radiographic fusion was achieved in all 4 cases, with satisfactory clinical outcome in 3 out of 4 cases, supporting this surgical technique as a definitive option for patients who have failed multiple CMC arthroplasty revision surgeries.
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Affiliation(s)
- Eric R Taleghani
- Department of Orthopaedic Surgery, University of Virginia Charlottesville, VA
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10
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Muir L. Trapeziometacarpal joint arthritis - imaging and implants: commentary and personal opinions. J Hand Surg Eur Vol 2023; 48:159-161. [PMID: 36524279 DOI: 10.1177/17531934221143439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Lindsay Muir
- Salford Royal NHS Foundation Trust, Salford, UK.,
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11
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Komura S, Hirakawa A, Masuda T, Nohara M, Kimura A, Matsushita Y, Matsumoto K, Akiyama H. Preoperative prognostic factors associated with poor early recovery after trapeziectomy with ligament reconstruction and tendon interposition arthroplasty for thumb carpometacarpal osteoarthritis. Orthop Traumatol Surg Res 2022; 108:103191. [PMID: 34952216 DOI: 10.1016/j.otsr.2021.103191] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/05/2021] [Accepted: 06/01/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Trapeziectomy with ligament reconstruction and tendon interposition (LRTI) is performed for treating thumb carpometacarpal osteoarthritis. However, patients occasionally experience delayed postoperative recovery. Although several prognostic factors associated with long-term outcomes have been identified, the factors associated with delayed recovery after trapeziectomy with LRTI have not been identified. HYPOTHESIS When we define major disability in the early postoperative period at 3 months after LRTI surgery as delayed recovery, some preoperative factors can influence with delayed recovery. Moreover, delayed recovery can influence the long-term therapeutic outcome. PATIENTS AND METHODS Thirty thumbs that underwent trapeziectomy with LRTI (mean follow-up period, 29.3 months) were retrospectively analyzed. Major disability was defined by both DASH and Hand20 scores≥35 after surgery, and patients were divided into groups 1 (major disability; n=9) and 2 (no major disability; n=21) according to the scores at 3 months after surgery. Preoperative data, including age, sex, preoperative symptom duration, dominant hand surgery, concurrent surgery with LRTI, previous orthopedic surgery, employment, stage of osteoarthritis, thickness of the trapezium, metacarpophalangeal hyperextension deformity, DASH score, Hand20 score, visual analogue scale (VAS) scores for pain, grip strength, pinch strength, and range of motion of the thumb were compared between groups to identify the factors indicating a poor prognosis at 3 months after surgery. We also compared the clinical outcomes at the 12-month and final follow-up. RESULTS Dominant hand surgery, previous orthopedic surgery, and preoperative poor DASH score were significantly more frequent in group 1, while the other factors did not show significant intergroup differences. Moreover, group 1 showed significantly poorer DASH score, grip and pinch strength, and active flexion of the thumb metacarpal joint at both the 12-month and final follow-up. This group also showed significantly poorer Hand20 and VAS scores at the final follow-up. DISCUSSION Dominant hand surgery, previous orthopedic surgery, and preoperative poor DASH score were associated with poor recovery at 3 months after trapeziectomy with LRTI. Moreover, major disability at 3 months after surgery influenced poor clinical outcomes at the 12-month and final follow-ups. These data could be useful for counseling patients regarding the expected recovery duration and outcomes after LRTI surgery. LEVEL OF EVIDENCE IV; retrospective therapeutic study.
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Affiliation(s)
- Shingo Komura
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan.
| | - Akihiro Hirakawa
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Tomihiro Masuda
- Department of Rehabilitation Medicine, Gifu University Hospital, Gifu, Japan
| | - Marie Nohara
- Department of Rehabilitation Medicine, Gifu University Hospital, Gifu, Japan
| | - Ayaka Kimura
- Department of Rehabilitation Medicine, Gifu University Hospital, Gifu, Japan
| | - Yasuharu Matsushita
- Department of Rehabilitation Medicine, Gifu University Hospital, Gifu, Japan
| | - Kazu Matsumoto
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
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12
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"Suspensionplasty for Revision Thumb Carpometacarpal Osteoarthritis Surgery: Comparing Suture Button Suspensionplasty to Ligament Reconstruction and Tendon Interposition.". Plast Reconstr Surg 2022; 150:601-605. [PMID: 35791263 DOI: 10.1097/prs.0000000000009408] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Several surgical procedures have been described for the treatment of thumb carpometacarpal (CMC) osteoarthritis (OA), including suture button suspensionplasty (SBS) and ligament reconstruction and tendon interposition (LRTI). To date, no one procedure has demonstrated clinical superiority. SBS has achieved favorable outcomes at five years in primary cases, but has not been validated in revision surgery. This study evaluated SBS for revision of failed thumb CMC OA surgery and compared these outcomes to revision using LRTI. A retrospective chart review was performed to identify patients who underwent suspensionplasty with SBS or LRTI after failure of previous thumb CMC OA surgery since 2010. Eighteen patients were included, nine undergoing revision with SBS and nine undergoing revision with LRTI. Eighteen patients had mean final follow-up of 35 months. There were two complications in the LRTI group, none in the SBS group. No patients required additional surgery. The SBS group had an average visual analog scale (VAS) pain score improvement of 2.9, compared to 2.4 in the LRTI group. Average final QuickDASH was 15.1 in the SBS group, compared to 22.6 in the LRTI group. Mean operative time of 86.3 minutes in the SBS group was significantly shorter than the 121 minute mean in the LRTI group. SBS is an effective treatment option for revision of previous thumb CMC OA surgery, with outcomes comparable to revision using LRTI, and the added benefit of shorter operative times and early mobilization.
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13
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Abstract
Revision thumb carpometacarpal (CMC) arthroplasty alleviates persistent pain and instability after nonimplant or implant CMC arthroplasty. Metacarpal subsidence onto the scaphoid causing impingement, missed diagnosis such as scaphotrapezoid arthritis, and metacarpophalangeal hyperextension are common causes of failed CMC arthroplasty. Literature shows that revision CMC arthroplasty has satisfactory outcomes. Currently, the mantra of revision is to restore the metacarpal height and treat concomitant pathology, but no single operation is a universal solution. Revision CMC arthroplasty has a relatively high complication rate, lower patient satisfaction than primary CMC arthroplasty, and may result in the need for further operative intervention.
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Affiliation(s)
- Shepard P Johnson
- Department of Surgery, Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Kevin C Chung
- Department of Surgery, Section of Plastic Surgery, University of Michigan Medical School, University of Michigan, 2130 Taubman Center, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0340, USA.
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14
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A Case of Carpal Tunnel Syndrome Resulting from Interference Screw Malposition after LRTI. Plast Reconstr Surg Glob Open 2022; 10:e4254. [PMID: 35433157 PMCID: PMC9007219 DOI: 10.1097/gox.0000000000004254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/15/2022] [Indexed: 11/27/2022]
Abstract
Many approaches to CMC arthroplasty have been described for treatment of advanced arthritis, yet there is no consensus on the “best” operation. Implantable hardware is increasingly utilized for metacarpal suspension, but few hardware-mediated complications have been documented. Here we present the case of a 69-year-old man with insidious-onset median neuropathy following ligament reconstruction and tendon interposition for CMC arthritis, utilizing interference screw fixation. After surgery, the patient developed median neuropathy, and his physical examination and MRI demonstrated a mass in the volar wrist. Operative exploration revealed an interference screw that was lodged immediately volar to the transverse carpal ligament, causing median nerve compression. Median neurolysis and screw removal led to symptom resolution. Carpal tunnel syndrome is an unreported complication of interference screw use during thumb CMC arthroplasty, and should be considered in patients with postoperative median neuropathy following ligament reconstruction and tendon interposition.
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15
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Hozack BA, Fram B, Ilyas AM, Rivlin M, Liss FE, Jones CM. Optimal Position of the Suture Button Suspensionplasty (TightRope) for Thumb Basal Joint Arthritis. Hand (N Y) 2022; 17:79-84. [PMID: 32108521 PMCID: PMC8721792 DOI: 10.1177/1558944720906551] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Surgical treatment of basal joint arthritis commonly consists of trapeziectomy followed by various suspensionplasty techniques to provide stability to the thumb ray. Our study goal was to assess the motion and stability of the thumb ray after trapeziectomy and placement of a suture button (Mini TightRope®, Arthrex, Naples, Florida) in a high- or low-angle trajectory. We hypothesized that a low-angle trajectory would yield the greatest stability while providing maximal motion of the thumb. Methods: Eleven fresh-frozen cadaver arms were imaged fluoroscopically in anterior-posterior and lateral views before and after trapeziectomy, and after placement of low- and high-angle suture buttons. The intermetacarpal angle between the thumb and index metacarpals was measured after application of a standard force. Radial abduction, opposition, subsidence, palmar abduction, adduction, and subsidence were measured. Results: Compared to posttrapeziectomy constructs, low- and high-angle TightRope constructs demonstrated less subsidence, low-angle TightRopes had less palmar abduction, and high-angle TightRope constructs had less radial abduction and adduction. High-angle TightRopes allowed more palmar abduction than low-angle constructs. The high-angle TightRopes trended toward more subsidence than low-angle constructs, although it was not significant. Conclusions: Both TightRope constructs provided improved axial stability after trapeziectomy while not excessively limiting any one motion of the thumb. Compared to the high-angle trajectory, the low-angle TightRope placement provided a more stable construct with respect to subsidence and angular motion. Given the concern for excessive motion of the first metacarpal base with the high-angle construct, we recommend a low-angle trajectory TightRope placement.
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Affiliation(s)
- Bryan A. Hozack
- Thomas Jefferson University Hospitals, Philadelphia, PA, USA,Bryan A. Hozack, Rothman Institute, Thomas Jefferson University Hospitals, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA.
| | - Brianna Fram
- Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Asif M. Ilyas
- Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Michael Rivlin
- Thomas Jefferson University Hospitals, Philadelphia, PA, USA
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16
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[Experiences with arthroplasty of the basal joint of the thumb : The"mini-hip" gains ground]. DER ORTHOPADE 2021; 51:29-35. [PMID: 34919162 DOI: 10.1007/s00132-021-04196-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 10/19/2022]
Abstract
The complex kinematics of the saddle joint has been a challenge in the development of trapeziometacarpal prostheses. The introduction of the dual-mobility design increases the range of motion and limits strains on the cup fixation. Therefore, rates of loosening and dislocation have been markedly reduced. Furthermore, several studies showed a similar relief of pain, range of movement and grip strength compared to the results of resection arthroplasty. The preservation of the length of the first ray as well as the more stable and functional joint can be favourable in younger and active patients. Further investigation is needed to determine whether or not those higher demands affect long-term survivorship. The high grade of patient satisfaction, the shorter recovery time and the safe surgical technique motivates considering the implantation of a total endoprosthesis with a dual-mobility cup as an attractive alternative to resection arthroplasty in the operative treatment for trapeziometacarpal osteoarthritis.
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17
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Herren DB, Fuchs N, Schindele S, Marks M. Outcomes and recommendations for revision of thumb carpometacarpal resection arthroplasty. J Hand Surg Eur Vol 2021; 46:1101-1107. [PMID: 34670435 DOI: 10.1177/17531934211050559] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study investigated revision surgery for the thumb after failed trapeziectomy with ligament reconstruction and tendon interposition and defined a revision concept. Twenty-four patients with 25 affected thumbs were examined at a mean of 5.5 years after their last revision operation. Pain during daily activities was 2.7 on a 0-10 numeric rating scale, pain at rest was 1.6 and the brief Michigan Hand Outcomes Questionnaire score was 63. Although 68% of patients indicated that their thumb was better than before primary surgery, the outcome after revision surgery was less favourable than that reported for primary trapeziectomy with ligament reconstruction and tendon interposition. We defined a revision algorithm to use as a guide for patients with residual symptoms after resection arthroplasty. The main reason for revision, symptomatic impingement of the thumb metacarpal, should be treated with resection of the metacarpal base and scaphotrapezoidal joint. An existing interposition should be revised, or a new interposition should be used, preferably with an autologous tendon or alternately with an allograft.Level of evidence: IV.
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Affiliation(s)
- Daniel B Herren
- Department of Hand Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Nina Fuchs
- Department of Hand Surgery, Schulthess Klinik, Zurich, Switzerland
| | | | - Miriam Marks
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland *Both authors equally contributed to this paper
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Update on Thumb Basal Joint Arthritis Surgery. Plast Reconstr Surg 2021; 148:811e-824e. [PMID: 34705791 DOI: 10.1097/prs.0000000000008487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Comprehend anatomy and biomechanics of the normal and arthritic trapeziometacarpal joint. 2. Evaluate best evidence for diagnosis and for operative and nonoperative treatment of thumb osteoarthritis. 3. Understand treatment pitfalls of basilar joint arthritis and complication avoidance. SUMMARY Articular and ligamentous anatomy of the trapeziometacarpal joint enables complex motions. Disability from arthritis, common at the trapeziometacarpal joint, is debilitating. Furthering the understanding of how trapeziometacarpal arthritis develops can improve treatment. The authors provide current best evidence for diagnosis and treatment of basilar joint arthritis. Pitfalls in treatment are discussed.
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Lavignac P, Legallois Y, Meynard P, Lacroix PM, Abi-Chahla ML, Bovet JL. Revision of failed trapeziometacarpal prothesis by CMI pyrocarbon implant: Retrospective study of 28 patients with a mean follow-up of 7.5 years. Orthop Traumatol Surg Res 2021; 107:102984. [PMID: 34116234 DOI: 10.1016/j.otsr.2021.102984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 05/22/2020] [Accepted: 06/01/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION There is no consensus on the best salvage option after a failed trapeziometacarpal prothesis. Conserving the trapezium and inserting a pyrocarbon hemiarthroplasty implant will prevent thumb shortening and preserve the thumb's motion. The aim of this study was to evaluate the clinical and radiological outcomes in the medium term of trapeziometacarpal prothesis revisions done using the CMI pyrocarbon implant. PATIENTS AND METHODS This was a retrospective study of 28 patients with a mean age of 63.5 years. The mean time to revision was 6.1 years after the initial arthroplasty. The dominant side was operated in 70% of patients. The surgery consisted of removing the existing prosthesis, reconstructing the trapezium with a bone graft, and inserting the CMI pyrocarbon implant. The review consisted of a functional assessment (visual analog scale for pain, QuickDASH score, patient satisfaction), physical assessment (Kapandji, grip strength, key pinch strength, tip pinch strength) and radiological assessment (complications, radiolucent lines, scaphometacarpal height, implant centering, bone remodeling). RESULTS At a mean follow-up of 7.5 years, no further surgical revisions were needed. The mean QuickDASH score was 1.1 and the mean QuickDASH was 13%. Twenty-five patients (89%) were satisfied with the outcome. The Kapandji score improved significantly from 7.5 to 9.5 on average. Grip strength improved significantly from 16.7kg to 21.5kg on average. The mean postoperative key pinch strength was 93% of the contralateral side. The mean postoperative tip pinch strength was 88% of the contralateral side. There were no fractures or dislocations visible on the radiographs. However, there was bone remodeling in the trapezium related to the pyrocarbon implant's indentation that was well tolerated by patients in the medium term. CONCLUSION For revision of failed trapeziometacarpal prothesis, inserting the CMI pyrocarbon implant combined with trapezium reconstruction appears to be a good alternative to the more commonly used trapeziectomy procedure. Reconstructing the trapezium and inserting this hemiarthroplasty implant preserves the thumb's projection, length, and stability. The functional improvement experienced by patients makes this a relevant treatment option. LEVEL OF EVIDENCE IV; retrospective study without control group.
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Affiliation(s)
- Pierre Lavignac
- Service de chirurgie orthopédique et traumatologique, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France.
| | - Yohan Legallois
- Service de chirurgie orthopédique et traumatologique, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - Pierre Meynard
- Service de chirurgie orthopédique et traumatologique, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - Paul-Maxime Lacroix
- Service de chirurgie orthopédique et traumatologique, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - Marie-Laure Abi-Chahla
- Service de chirurgie orthopédique et traumatologique, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
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Komura S, Hirakawa A, Masuda T, Nohara M, Kimura A, Matsushita Y, Akiyama H. Does trapeziectomy with ligament reconstruction and tendon interposition arthroplasty correct the metacarpophalangeal joint hyperextension associated with trapeziometacarpal osteoarthritis? Arch Orthop Trauma Surg 2021; 141:1261-1268. [PMID: 33649913 DOI: 10.1007/s00402-021-03838-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 02/15/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Trapeziometacarpal osteoarthritis sometimes results in hyperextension of the thumb metacarpophalangeal (MCP) joint, which could negatively impact outcomes following trapeziectomy with ligament reconstruction and tendon interposition (LRTI) arthroplasty. Although algorithms on performing trapeziectomy with LRTI for the management of this deformity are available, they lack clear evidence. Here, we investigate the function of the thumb MCP joint after trapeziectomy with LTRI and whether this procedure alone corrects preoperative MCP hyperextension, and also analyze clinical factors correlated with MCP hyperextension post-surgery. MATERIALS AND METHODS Twenty-eight patients who underwent trapeziectomy with LRTI and followed up for at ≥ 1 year (mean, 27.2 months) were retrospectively analyzed. No patient had concomitant surgery to the thumb MCP joint at the time of trapeziectomy with LRTI. Patients were divided into the < 30° (n = 19) and > 30° (n = 9) hyperextension groups as per their preoperative passive range of motion (ROM) of the MCP joint. Changes in ROM of the MCP joint post-surgery, clinical factors correlated with postoperative MCP hyperextension, and correlations between clinical outcomes and postoperative MCP extension were analyzed. RESULTS In the < 30° MCP hyperextension group, active and passive extensions of the MCP joint did not significantly change after surgery, and no worsening of postoperative MCP hyperextension was observed. In the > 30° hyperextension group, passive extension of the MCP joint significantly decreased (mean, 49.6°-29.8°). Preoperative MCP hyperextension improved in seven patients, was unchanged in 1, and worsened in 1. Postoperative passive MCP extension was negatively correlated with active/passive radial abduction, MCP flexion, trapezial space height, subjective outcomes, and hand strength post-surgery. CONCLUSIONS Trapeziectomy with LRTI alone could prevent postoperative thumb MCP hyperextension deformity for patients with thumb MCP extension < 30° and improve preoperative thumb MCP hyperextension. However, for patients with loss of radial abduction and MCP flexion due to the contracture, indirect correction of the MCP hyperextension was improbable.
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Affiliation(s)
- Shingo Komura
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Yanagido 1-1, Gifu, 501-1194, Japan.
| | - Akihiro Hirakawa
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Yanagido 1-1, Gifu, 501-1194, Japan
| | - Tomihiro Masuda
- Department of Rehabilitation Medicine, Gifu University Hospital, Gifu, Japan
| | - Marie Nohara
- Department of Rehabilitation Medicine, Gifu University Hospital, Gifu, Japan
| | - Ayaka Kimura
- Department of Rehabilitation Medicine, Gifu University Hospital, Gifu, Japan
| | - Yasuharu Matsushita
- Department of Rehabilitation Medicine, Gifu University Hospital, Gifu, Japan
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Yanagido 1-1, Gifu, 501-1194, Japan
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De la Red-Gallego MA, Barrera-Ochoa S, Sanchez Crespo MR. Total thumb carpometacarpal arthroplasty for failed trapeziometacarpal joint arthrodesis. HAND SURGERY & REHABILITATION 2021; 40:347-349. [PMID: 33640520 DOI: 10.1016/j.hansur.2020.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 11/17/2022]
Abstract
Trapeziometacarpal joint arthrodesis is a surgical option for osteoarthritis of the first carpometacarpal joint; however, it has well-known disadvantages such as non-union and reduced mobility. Revision procedures are often not discussed and lack consensus. We are reporting two cases of satisfactory thumb implant arthroplasty for failed trapeziometacarpal joint arthrodesis in order to discuss the surgical technique, its advantages compared with other surgical options and therefore its potential indications.
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Affiliation(s)
- M A De la Red-Gallego
- Hospital Universitario Marqués de Valdecilla, Avenida de Valdecilla s/n., 39010 Santander, Cantabria, Spain.
| | - S Barrera-Ochoa
- icatMA, Hand and Microsurgery Unit, ICATME, Hospital Universitari Quiron-Dexeus, Carrer de Sabino Arana, 5-19, 08028 Barcelona, Spain
| | - M R Sanchez Crespo
- Hospital Universitario Marqués de Valdecilla, Avenida de Valdecilla s/n., 39010 Santander, Cantabria, Spain
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22
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Ashford-Wilson S, Ghazala CG, McLaughlin K, Harrison JWK. Failed Trapeziectomy Treated by Thumb Metacarpal Base Arthrodesis: A Case Series. Tech Hand Up Extrem Surg 2021; 25:219-225. [PMID: 33538463 DOI: 10.1097/bth.0000000000000338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Trapeziometacarpal joint arthritis is a prevalent condition with a preponderance to women. Most cases are asymptomatic, but typical symptoms are pain, reduced dexterity, and functional decline. Trapeziectomy is the most common surgical treatment in the United Kingdom for patients who remain significantly symptomatic despite nonoperative measures, and this generally produces acceptable outcomes; however, a proportion of patients remain significantly symptomatic. The authors present a case series of 4 patients who underwent successful thumb metacarpal base to index metacarpal base arthrodesis with either distal radial or iliac crest bone grafting. Three of these patients had persisting symptoms after a primary trapeziectomy and 1 patient had gross subluxation of the thumb related to rheumatoid arthritis. Technically, this is a simple procedure to perform. All patients had improved symptoms with satisfactory functional outcomes and an improved cosmetic appearance of the hand.
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Affiliation(s)
| | | | - Kealan McLaughlin
- Department of Trauma & Orthopaedic Surgery, Queen Elizabeth Hospital, Gateshead, England
| | - John W K Harrison
- Department of Trauma & Orthopaedic Surgery, Queen Elizabeth Hospital, Gateshead, England
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Scaphometacarpal arthrodesis with autologous structural bone graft as a salvage procedure after failed trapeziectomy – Surgical technique and initial results. HAND SURGERY & REHABILITATION 2020; 39:539-544. [DOI: 10.1016/j.hansur.2020.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/28/2020] [Accepted: 06/29/2020] [Indexed: 11/23/2022]
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Thumb Carpometacarpal Suspension Arthroplasty With Flexor Carpi Radialis Ligament Reconstruction and Tendon Interposition Using An Absorbable Interference Screw: A Volar Approach Technique. Tech Hand Up Extrem Surg 2020; 25:102-107. [PMID: 33060462 DOI: 10.1097/bth.0000000000000317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The goal of operative intervention for pantrapezial arthritis is to relieve pain, maintain or improve motion, stability, and strength, and restore function. The purpose of this article is to present a volar approach to thumb carpometacarpal suspension arthroplasty using an absorbable interference screw for flexor carpi radialis ligament reconstruction and tendon interposition in the treatment of pantrapezial arthritis. This technique allows for visualization of the volar beak and avoidance of the radial artery and the branches of the superficial radial nerve while allowing optimal surgical manipulation for suspensionplasty with interference screw fixation and tendon interposition at the carpometacarpal joint.
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Froschauer SM, Holzbauer M, Schnelzer RF, Behawy M, Kwasny O, Aitzetmüller MM, Machens HG, Duscher D. Total arthroplasty with Ivory ® prosthesis versus resection-suspension arthroplasty: a retrospective cohort study on 82 carpometacarpal-I osteoarthritis patients over 4 years. Eur J Med Res 2020; 25:13. [PMID: 32295633 PMCID: PMC7161197 DOI: 10.1186/s40001-020-00411-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 03/26/2020] [Indexed: 11/30/2022] Open
Abstract
Background To elucidate the performance of carpometacarpal-I joint prostheses in comparison with the current gold standard treatment, resection–suspension arthroplasty (RA), we conducted a study comparing outcomes of the Ivory prosthesis to those of a cohort of patients receiving RA. Methods Initially, we had enrolled 34 prosthesis patients and 48 RA patients, of which 5 and 11 were lost to follow-up. We defined Eaton/Littler stage 3 osteoarthritis, no previous surgery, no concomitant arthrosis, no rheumatic arthritis, no history of trauma and a minimum follow-up period of 2 years as inclusion criteria. We assessed patient demographics, disability of the arm, shoulder, and hand score, pain via visual analogue scale, subjective strength of the thumb, range of motion (radial and palmar abduction and opposition), and patient satisfaction. All occurring complications were recorded. Results Follow-up included a mean period of 4.5 years (2–7.4) in the prosthesis cohort and 4.1 years (2–6.8) in the RA group. Disability of the arm, shoulder, and hand scores, pain scores, palmar abduction and opposition, and subjective satisfaction showed no significant differences between the two cohorts. Postoperative loss of strength was significantly less in the prosthesis group (p = 0.01). Moreover, we were able to demonstrate better range of motion in terms of radial abduction in the prosthesis group (p = 0.001). The overall complication rate was significantly higher in the prosthesis cohort (41.4% vs. 10.8%) (p = 0.008). Nevertheless, the Ivory prosthesis group showed a survival rate of 93.1%. Conclusion As the high complication rate is compensated by a better functional outcome (enhanced range of motion and strength), we believe that prosthesis implantation can be a reasonable treatment option for carpometacarpal-I osteoarthritis in a particular patient group. Level of Evidence IIIl: Retrospective cohort study.
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Affiliation(s)
- Stefan M Froschauer
- Department for Trauma Surgery and Sport Traumatology, Kepler University Hospital Linz, Medcampus III, Krankenhausstrasse 3, 4020, Linz, Austria.,Medical Faculty, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020, Linz, Austria
| | - Matthias Holzbauer
- Department for Trauma Surgery and Sport Traumatology, Kepler University Hospital Linz, Medcampus III, Krankenhausstrasse 3, 4020, Linz, Austria.,Medical Faculty, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020, Linz, Austria
| | - Richard F Schnelzer
- Department for Trauma Surgery and Sport Traumatology, Kepler University Hospital Linz, Medcampus III, Krankenhausstrasse 3, 4020, Linz, Austria
| | - Manfred Behawy
- Department for Trauma Surgery and Sport Traumatology, Kepler University Hospital Linz, Medcampus III, Krankenhausstrasse 3, 4020, Linz, Austria
| | - Oskar Kwasny
- Department for Trauma Surgery and Sport Traumatology, Kepler University Hospital Linz, Medcampus III, Krankenhausstrasse 3, 4020, Linz, Austria.,Medical Faculty, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020, Linz, Austria
| | - Matthias M Aitzetmüller
- Department for Plastic and Hand Surgery, Technical University Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Hans-Günther Machens
- Department for Plastic and Hand Surgery, Technical University Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Dominik Duscher
- Department for Trauma Surgery and Sport Traumatology, Kepler University Hospital Linz, Medcampus III, Krankenhausstrasse 3, 4020, Linz, Austria. .,Department for Plastic and Hand Surgery, Technical University Munich, Ismaninger Strasse 22, 81675, Munich, Germany. .,Section for Plastic and Reconstructive Surgery, Kepler University Hospital Linz, Medcampus III, Krankenhausstrasse 3, 4020, Linz, Austria. .,Medical Faculty, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020, Linz, Austria.
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Komura S, Hirakawa A, Masuda T, Nohara M, Kimura A, Matsushita Y, Akiyama H. Chronological changes in surgical outcomes after trapeziectomy with ligament reconstruction and tendon interposition arthroplasty for thumb carpometacarpal osteoarthritis. Orthop Traumatol Surg Res 2020; 106:357-364. [PMID: 31982383 DOI: 10.1016/j.otsr.2019.11.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 10/21/2019] [Accepted: 11/13/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Despite satisfactory mid-term and long-term outcomes of trapeziectomy with ligament reconstruction and tendon interposition (LRTI) procedures for thumb carpometacarpal osteoarthritis, there is limited literature describing detailed chronological changes in early-phase postoperative outcomes. We investigated chronological changes of subjective, objective, and radiological outcomes within 1 year post-trapeziectomy with LRTI using a longitudinal evaluation and analyzed clinical factors associated with patient-reported subjective outcomes. HYPOTHESIS Some parameters influence patient-reported subjective outcomes during the early postoperative period. PATIENTS AND METHODS Nineteen patients (mean age, 67.3 years) who underwent trapeziectomy with LRTI were evaluated preoperatively and at 3, 6, and 12 months postoperatively to investigate objective (grip strength, pinch strength, range of motion [ROM] of the interphalangeal [IP] joint, metacarpophalangeal [MP] joint, and carpometacarpal [CMC] joint, Kapandji score), subjective (Disabilities of the Arm, Shoulder, and Hand [DASH] score, Hand20 questionnaire score, and visual analog scale [VAS] for pain), and radiological outcomes (trapezial space height and its ratio). Factors affecting DASH and Hand20 scores were analyzed. RESULTS Grip strength and pinch strength were decreased at 3-month follow-up. It required 6 months to recover preoperative strength and 12 months for significant improvement. VAS for pain, DASH, and Hand20 scores were significantly improved at 3-month follow-up, continuing to improve until 12 months. The trapezial space height and its ratio decreased approximately 50% at 3-month follow-up, with no further changes at 6 or 12 months. Both DASH and Hand20 scores were strongly correlated with VAS for pain during activity within 6 months post-surgery and moderately correlated with ROM of the thumb at 3 months post-surgery; however, they were not correlated with grip and pinch strength as well as the trapezial space height ratio within 12 months post-surgery. DISCUSSION Trapeziectomy with LRTI for thumb carpometacarpal osteoarthritis provided early subjective improvements in outcomes as early as 3 months post-procedure. However, more than 6 months are required to determine objective improvements in outcomes. To obtain early patient-reported satisfactory outcomes, we should focus not on improving hand and finger strength, but on treating postoperative surgical site pain and preventing thumb stiffness. LEVEL OF EVIDENCE IV, retrospective therapeutic study.
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Affiliation(s)
- Shingo Komura
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Yanagido 1-1, Gifu 501-1194, Japan.
| | - Akihiro Hirakawa
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Yanagido 1-1, Gifu 501-1194, Japan
| | - Tomihiro Masuda
- Department of Rehabilitation Medicine, Gifu University Hospital, Gifu, Japan
| | - Marie Nohara
- Department of Rehabilitation Medicine, Gifu University Hospital, Gifu, Japan
| | - Ayaka Kimura
- Department of Rehabilitation Medicine, Gifu University Hospital, Gifu, Japan
| | - Yasuharu Matsushita
- Department of Rehabilitation Medicine, Gifu University Hospital, Gifu, Japan
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Yanagido 1-1, Gifu 501-1194, Japan
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