Efficacy of Surgical Interventions for Trapeziometacarpal (Thumb Base) Osteoarthritis: A Systematic Review

Resection arthroplasty versus dual mobility prosthesis in the treatment of trapeziometacarpal joint osteoarthritis: A 3 year non-randomized prospective study

Purpose

Resection arthroplasty (RA) is still the most common surgical intervention for the treatment of symptomatic trapeziometacarpal (TMC) joint osteoarthritis. The implantation of a dual mobility prosthesis may represent a joint function preserving alternative. The aim of the presented study is to prospectively compare the outcomes of RA with dual mobility prosthesis.

Methods

In this 2-center non-randomized prospective study, we compared results of RA (n = 22) with implantation of a dual mobility prosthesis (n = 49) (Touch®) at a minimum of 3-year follow-up. The patients underwent preoperative assessments and postoperative follow-up at 6 weeks, 3, 6, 12, 24, and 36 months. Comparisons were conducted, covering pain assessment via the visual analogue scale (VAS), thumb range of motion (ROM), pinch and grip strength, as well as functional scores and radiological examinations.

Results

The time intervals from surgery until absence of pain on the VAS (3 months: 3 vs 1, p = 0.0001), recovery of ROM in radial (3 months: 33° vs 42°, p = 0.0001), and palmar abduction (3 months: 33° vs 48°, p = 0.0001), were significantly longer for the RA group compared with the prosthesis group. At 3-year follow-up there was no significant difference in absence of pain, ROM and grip strength between both groups. Key pinch strength was significantly weaker in the RA group compared to prosthesis group at 3 months (2.6 kg vs 4.6 kg, p = 0.001), to 3-year follow-up (3.1 kg vs 5.7 kg, p = 0.0001). The final mean DASH (15.5 vs 13.2, p = 0.01) and MHQ scores (78 vs 82, p = 0.01) were significantly better in the prosthesis group.

Conclusion

Both techniques show high patient satisfaction in mid-term follow-up. Dual mobility TMC joint arthroplasty seems to be associated with a superior pinch strength and shorter time of recovery as compared to patients after RA.

[Current Trends in the Implantation of the Touch Prosthesis at the Thumb Carpometacarpal Joint: Results of the 1st German-Speaking User Meeting]

The introduction of the new generation of thumb carpometacarpal (CMC I) joint implants for the treatment of CMC I osteoarthritis has significantly broadened the scope of hand surgery in recent years. However, the technical demands of the procedure and the many details that need to be considered require appropriate training and a learning curve. To share experiences with the Touch CMC I prosthesis, we held the first German-speaking CMC I joint prosthetics user meeting in Zurich. After some basic introductory lectures on biomechanics and the principles of prosthetic fitting of the CMC I joint, the various challenges associated with CMC I joint prosthetics were discussed in interactive expert panels. Subsequently, cases were discussed in small groups under expert guidance and the respective conclusions were discussed in plenary. The main results of this symposium are summarised in this manuscript.

Tenoplasty in suspension with or without tendon interposition: A prospective randomized study in the treatment of advanced thumb carpometacarpal arthritis

Introduction

The aim of this prospective and randomized study is to analyze and compare the outcomes of two surgical techniques for trapeziometacarpal joint osteoarthritis (Eaton-Littler grade III and IV).

Materials and methods

52 consecutive patients underwent surgical intervention by two different surgical techniques and checked for subjective outcomes (DASH, NPRS), objective outcomes (ROM, opposition test, grinding test, pulp pinch, hand grip) and radiographic outcomes. Surgical time was calculated.

Results

26 patients underwent suspension arthroplasty using abductor pollicis longus tendon interposition (Ceruso procedure) and 26 patients underwent arthroplasty using suspension tenoplasty of the flexor radialis carpi (Altissimi procedure). Both techniques were performed by a single surgeon and showed good and satisfactory results, with best outcome reported in Altissimi procedure regarding DASH and ROM (p = 0.011 and p = 0.012, respectively), with reduced surgical time (about 6 min less, p = 0.03). The proximal shift between scaphoid and the base of first metacarpal did not influence the final results of the cases treated.

Conclusion

This study provides evidence that trapeziectomy in combination with both tendon suspension arthroplasty and tendon interposition are two surgical procedures useful to solve advanced basal joint arthritis. Patients who underwent suspension tenoplasty without tendon interposition seemed to be generally more satisfied with significantly better symptomatic and functional outcomes.

Arthroscopic Hemitrapeziectomy: Is an Internal Brace Worth It?

BACKGROUND

This article's purpose was to analyze clinical results obtained with thumb carpometacarpal (CMC) arthroscopic hemitrapeziectomy with temporary suspension with a Kirschner wire (K-wire).

METHODS

Seventy thumb CMC arthroscopic hemitrapeziectomies with a mean age of 59 and 18 months of follow-up were performed in our center during a 13-year period. All of them followed the same protocol. Surgical technique is described.

RESULTS

All patients were arthroscopically classified as Badia's III stage. No tendon interposition was used, and a K-wire was temporarily implanted for 5.1 weeks. Mean postsurgical Visual Analogue Scale of 1.6, Kapandji Opposition Score of 8.1, grip strength of 42.2 lbs, lateral pinch of 9.5 lbs, tip-to-tip pinch of 4.2 lbs and tripod pinch of 7.8 lbs were measured. All previous active workers resumed their previous job.

CONCLUSIONS

We conclude that thumb CMC arthroscopic hemitrapeziectomy with temporary suspension with K-wire reaches good results in terms of pain reduction, strength, and functionality, without the necessity of an internal brace which increases risks of a second metacarpal fracture.

Basal thumb arthritis surgery: complications and its management

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.

The Relationship Between Patient-Reported Outcomes and Patient Satisfaction With Ligament Reconstruction Tendon Interposition

PURPOSE

Achieving the minimal clinically important difference (MCID) on an outcomes instrument and reporting satisfaction with surgical outcomes are not equivalent. We hypothesized that improvement exceeding the QuickDASH and PROMIS UE CAT MCID is associated with a greater likelihood of reporting satisfaction with ligament reconstruction tendon interposition (LRTI) treatment. Our secondary hypothesis was that a subset of patients failing to meet MCID would still be satisfied.

METHODS

Patients ≥1 year after LRTI at one academic tertiary institution were included. QuickDASH and UE CAT v1.2 scores were obtained before and after surgery. Postoperative satisfaction and levels of improvement in pain and function were also obtained.

RESULTS

A total of 93 patients completed the QuickDASH, and of those, 90 also completed the UE CAT. At a mean of 2.6 ± 1.0 years after surgery, QuickDASH and UE CAT score improvement exceeded the previously published MCID estimates of 8.8 and 4.8. Although 90% (84/93) of the patients reported satisfaction, only 85% (72/93) and 72% (59/90) achieved MCID on the QuickDASH and UE CAT, respectively. Using the MCID estimate of 8.8, 96% (72/75) of the patients meeting the MCID were satisfied with their treatment. Those failing to achieve MCID reported significantly less physical function and pain improvement; however, most were satisfied nonetheless (68% [13/19] for QuickDASH, 77% [23/30] for UE CAT).

CONCLUSIONS

Achieving published MCID thresholds on the QuickDASH and PROMIS UE CAT v1.2 was predictive of patients reporting general satisfaction with their LRTI outcome ≥1 year after surgery. Most patients failing to achieve MCID still reported satisfaction with their LRTI. Achieving MCID thresholds alone should not be used as a surrogate for patient satisfaction with their treatment. Patient satisfaction is a complicated construct that is potentially very different from that of high-quality care.

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognostic IV.

Total joint arthroplasty versus trapeziectomy in the treatment of trapeziometacarpal joint arthritis: a randomized controlled trial

The aim of this double anonymized, randomized controlled trial was to determine whether total joint arthroplasty has superior outcomes than trapeziectomy 1 year after surgery for trapeziometacarpal osteoarthritis. A total of 62 women aged 40 years and older, scheduled for surgery for stage II or III osteoarthritis of the trapeziometacarpal joint, were included and randomized to trapeziectomy or total joint arthroplasty. The primary outcome was the total score of the Michigan Hand Outcomes Questionnaire. Secondary outcomes were the Michigan Hand Outcomes Questionnaire subscale scores, Disability of the Arm, Shoulder and Hand Questionnaire, active range of motion, strength, return to work, patient satisfaction and complications. Data were collected at baseline and at 3 and 12 months. At 1 year, we found no superiority of total joint arthroplasty over trapeziectomy regarding the total score of the Michigan Hand Outcomes Questionnaire. The total joint arthroplasty did show a significant advantage in strength and range of motion.Level of evidence: I.

Differences between trapeziometacarpal arthrodesis and trapeziectomy with ligament reconstruction for the treatment of trapeziometacarpal osteoarthritis: a systematic review and meta-analysis

The optimal management of trapeziometacarpal (TMC) osteoarthritis remains controversial. This meta-analysis assessed the subjective and objective outcomes of trapeziometacarpal arthrodesis (TMA) versus trapeziec-tomy with ligament reconstruction (LRTI). The PubMed, Cochrane Library, Embase, Web of science data-bases were searched from inception to June 30, 2022. Keywords included "trapeziometacarpal osteoarthrosis", "trapeziometacarpal arthrodesis" and "trapeziectomy with ligament reconstruction". Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) including patients treated for TMC osteoarthritis were included. The subjective outcomes visual analogue scale (VAS) , Patient-Rated Wrist and Hand Evaluation (PRWHE), Disabilities of arm, shoulder and hand (DASH) scores, Kapanji scores, objective outcomes total interphalangeal (IP) and metacarpophalangeal (MCP) joint motion, palmar abduction, grip strength, tip, key pinch strength and complications were extracted. The methodological quality of each was assessed in- dependently. Meta-analysis was performed for comparative trials. From the 5 included studies (2 RCTs, 3 CCTs), 208 cases were divided into TMA group (n = 107) and LRTI group (n =101) groups. Compared with the TMA group, PRWHE, tip pinch strength and palmar abduction was better in the LRTI group. There was no statistical difference in DASH score, VAS, kapandji score, grip strength, key pinch strength, total IP joint motion, total MCP joint motion and complications. The LRTI group had more obvious advantages in term of PRWHE, tip pinch strength and palmar abduction. Moreover, there was no statistical difference in DASH score, VAS, kapandji score, grip strength, key pinch strength, total IP joint and total MCP joint motion and complications. Therefore, we concluded LRTI was more recommendable for more management of TMC osteoarthritis. Certainly, high-quality studies are required in long-term follow-up.

Dual mobility prosthesis for trapeziometacarpal osteoarthritis: results from a prospective study of 55 prostheses

This prospective study evaluated outcomes after trapeziometacarpal joint replacement with a dual mobility prosthesis (Touch®) in 55 thumbs (52 patients) with a mean follow-up of 25 months (range 12-36). Pre- and postoperative assessments included pain, range of motion, the Kapandji index, pinch- and grip strength, as well as functional scores and radiological parameters. Mean preoperative metacarpophalangeal joint hyperextension of 19° (range 15°-28°) showed a significant correction after 1 year with a mean value of 2° (range 0°-5°). Mean Quick Disabilities of the Hand, Shoulder and Arm score was 14 (range 6-28), and Michigan Hand Questionnaire 82 (range 67-92). No revisions due to infection, loosening, dislocation or material failure occurred during follow-up. The dual mobility trapeziometacarpal joint prosthesis was a reliable treatment option to decrease pain, improve motion, strength and pre-existing metacarpophalangeal joint hyperextension at short-term follow-up.Level of evidence: IV.

Evaluation of Preoperative Factors Affecting Midterm Patient-Reported Outcomes Following Ligament Reconstruction Tendon Interposition: A Prognostic Study

PURPOSE

The aim of this study was to evaluate the prognostic value of preoperative patient-reported outcomes as predictors of functional improvement following ligament reconstruction tendon interposition. We hypothesized that high levels of preoperative pain interference (PI) and upper-extremity disability are associated with lower magnitudes of functional improvement ≥1 year after surgery on the shortened version of the Disabilities of the Arm, Shoulder, and Hand (QuickDASH) (primary outcome) and Patient-Reported Outcomes Measurement Information System Upper Extremity (UE) Computer Adaptive Test (CAT) (UE CAT) v1.2 (secondary outcome).

METHODS

Adult patients who underwent ligament reconstruction tendon interposition between February 2014 and April 2018 at an academic tertiary institution were considered for inclusion in this longitudinal cohort study. Patient-reported outcomes were collected at baseline and ≥1 year after surgery. Univariate and multivariable linear regression analyses were performed to identify factors associated with the magnitude of functional improvement on the QuickDASH and UE CAT.

RESULTS

Among 93 included participants, the mean age was 61 ± 7 years, and 75 (81%) were women. At 2.5 ± 1.0 years after surgery, the QuickDASH and UE CAT improved by a mean of 24.5 ± 20.9 and 9.9 ± 10.7 points, respectively. In the primary multivariable model, a greater preoperative QuickDASH (indicative of lower function; coefficient, 0.8; 95% confidence interval [CI], 0.6 to 0.9) and lower preoperative Performance of Patient-Reported Outcomes Measurement Information System PI CAT (eg, less pain interference; coefficient, -0.7; 95% CI, -1.2 to -0.2) were associated with greater QuickDASH improvement independent of potential confounders. In the secondary multivariable model, lower preoperative UE CAT (indicative of worse function; coefficient, -0.9; 95% CI, -1.1 to -0.7) and lower preoperative Patient-Reported Outcomes Measurement Information System PI CAT (coefficient, -0.3; 95% CI, -0.6 to -0.1) were associated with greater UE CAT improvement.

CONCLUSIONS

Preoperative patient-reported outcomes may be useful in understanding the degree of improvement that certain patient populations can expect from ligament reconstruction tendon interposition. Those with lower baseline (preoperative) upper-extremity function and PI are expected to derive the greatest functional improvement in the midterm.

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognostic IV.