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Adams AJ, Kasper A, Tosti R. Arthroscopic Total Trapeziectomy for Thumb Carpometacarpal Arthrosis. Hand (N Y) 2024:15589447241262055. [PMID: 39045649 DOI: 10.1177/15589447241262055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
BACKGROUND The purpose of this individual cohort study is to demonstrate safety and efficacy in removing the trapezium through minimally invasive arthroscopy. METHODS A prospective case series was performed on all arthroscopic total trapeziectomy procedures for thumb basal joint arthrosis between 2018 and 2022. Patients were followed for up to 1 year. All patients received an examination at each visit to include pain, range of motion, strength, and metacarpal height. Complications, concomitant procedures, and revision procedures were recorded as well. RESULTS A total of 49 arthroscopic trapeziectomy procedures were recorded for 46 patients. The average preoperative visual analog pain scale score was 8.8 out of 10, and the postoperative score was 1 out of 10. All patients had a resolution of the carpometacarpal grind test postoperatively. The average preoperative key pinch, 3-point chuck, and grip strength were 9.8 lbs/in2, 7.8 lbs/in2, and 45 lbs/in2, respectively. Final 6-month postoperative key pinch, 3-point chuck, and grip strength were 11.0 lbs/in2, 9.8 lbs/in2, and 49.2 lbs/in2, respectively. Metacarpal height subsided on average 50%. We report one revision and no cases of radial sensory neuritis or flexor tendon rupture. CONCLUSIONS Arthroscopic total trapeziectomy appears to be a safe and effective treatment for end-stage arthrosis of the thumb basal joint. LEVEL OF EVIDENCE 2b Therapeutic; Individual Cohort Study.
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Affiliation(s)
| | | | - Rick Tosti
- Thomas Jefferson University, Philadelphia, PA, USA
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Lui TH, Woo OFA, Slocum AMY. Arthroscopic Trapeziectomy Without Traction Tower. Arthrosc Tech 2024; 13:102879. [PMID: 38584630 PMCID: PMC10995698 DOI: 10.1016/j.eats.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/08/2023] [Indexed: 04/09/2024] Open
Abstract
Osteoarthritis in the thumb carpometacarpal joint causes pain, swelling, deformity, instability, loss of motion, and power, which seriously impairs overall hand function. Surgery is indicated if conservative treatment fails to relieve the pain. Trapeziectomy is the most popular surgical treatment choice and yields good range of motion and relieves pain with the fewest complications. Arthroscopic trapeziectomy is gaining popularity. In general, the arthroscopic procedure is performed under continuous traction with a traction tower. The purpose of this Technical Note is to describe the details of arthroscopic trapeziectomy without traction tower. This eliminates the need of a traction tower and continuous traction and provides a stable platform for the arthroscopic procedure.
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Affiliation(s)
- Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, Hong Kong SAR, China
| | | | - Amanda Mun Yee Slocum
- Department of Orthopaedics and Traumatology, North District Hospital, Hong Kong SAR, China
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Arthroscopic Trapeziectomy. Tech Hand Up Extrem Surg 2022; 26:267-270. [PMID: 35698313 DOI: 10.1097/bth.0000000000000397] [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
Several methods of resection arthroplasty for the thumb basal joint exist, yet one commonality of these procedures is the removal of the trapezium. My preference is to achieve total trapeziectomy through a less invasive approach and encourage immediate mobilization in order to expedite return to function. Herein I present a step by step method of arthroscopic total trapeziectomy without suspensionplasty.
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Donndorff AG, Rellan I, Gallucci GL, Boretto JG, Zaidenberg EE, De Carli P. Trapeziometacarpal osteoarthritis: Arthroscopic hemitrapeziectomy using the Thenar Portal. Orthop Traumatol Surg Res 2021; 107:102793. [PMID: 33333267 DOI: 10.1016/j.otsr.2020.102793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/07/2020] [Accepted: 08/17/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Although the standard 1Radial and 1Ulnar portals allow for visualisation of most of the trapezium articular surface, the proximity of these two portals can often make arthroscopic triangulation and visualisation of the most lateral capsule and joint surface challenging. Despite its already reported advantages in improving visualisation, there is little literature reporting the clinical experience with the Thenar Portal. The purpose of this study is to describe potential complications and the short-term clinical-radiographic outcomes of arthroscopic hemitrapeziectomy using the Thenar Portal in order to determine its safety and efficacy as a standard working portal. PATIENTS AND METHODS A retrospective chart review was conducted for all patients diagnosed with first carpometacarpal (CMC) osteoarthritis who were treated surgically with an arthroscopic hemitrapeziectomy. Only patients with stage II or III osteoarthritis and a minimum of 1-year follow-up were included. Twenty-two patients (24 thumbs) with an average age of 62 years met the inclusion criteria. The average follow-up was 52 months. Intra-operative and post-surgical complications were recorded. Objective evaluation consisted of an assessment of range of motion (ROM), grip and pinch strength. Subjective evaluation consisted of a DASH questionnaire and the visual analog scale to score pain at rest, during activities, and function. RESULTS There were no intra- or post-surgical complications. In one case, pain persisted with a poor functional result, requiring a revision surgery. Average range of motion (compared with the contralateral) showed a statistically significant improvement in palmar abduction and radial abduction of the CMC joint: 50° vs. 55° (p=0.01235), and 50° vs. 55° (p=0.06009), respectively. There was no statistically significant improvement in thumb adduction, grip strength, or lateral and tip-pinch. All patients achieved retropulsion with their affected thumb. According to the VAS, average rest pain improved from 7.5 to 0 (p<0.001) and from 9 to 0 (p<0.001) during activity. The average final function and QuickDASH were 9 (VAS) and 8, respectively (p<0.001). The average radiographic proximal migration of the first metacarpal was 2.9mm (range: 0.7-5.8mm). DISCUSSION Arthroscopic hemitrapeziectomy using the Thenar portal: 1) improved visualisation of the trapeziometacarpal joint, 2) facilitated arthroscopic triangulation, and 3) represents a safe and effective alternative for the treatment of thumb osteoarthritis, with pain relief and function improvement in most patients without a higher risk of complications. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Agustin Guillermo Donndorff
- Department of Orthopaedics, Italian Hospital of Buenos Aires, C1199ACK, 4215 Potosí, Buenos Aires, Argentina.
| | - Ignacio Rellan
- Department of Orthopaedics, Italian Hospital of Buenos Aires, C1199ACK, 4215 Potosí, Buenos Aires, Argentina
| | - Gerardo Luis Gallucci
- Department of Orthopaedics, Italian Hospital of Buenos Aires, C1199ACK, 4215 Potosí, Buenos Aires, Argentina
| | - Jorge Guillermo Boretto
- Department of Orthopaedics, Italian Hospital of Buenos Aires, C1199ACK, 4215 Potosí, Buenos Aires, Argentina
| | - Ezequiel Ernesto Zaidenberg
- Department of Orthopaedics, Italian Hospital of Buenos Aires, C1199ACK, 4215 Potosí, Buenos Aires, Argentina
| | - Pablo De Carli
- Department of Orthopaedics, Italian Hospital of Buenos Aires, C1199ACK, 4215 Potosí, Buenos Aires, Argentina
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Corella F, Ocampos M, Laredo R, Tabuenca J, Carnicer M, Larrainzar-Garijo R. Arthroscopic Trapeziectomy and Suture Button Suspensionplasty: A Review of the Literature and Description of the "Three-Step Arthroscopic Trapeziectomy Technique". J Wrist Surg 2020; 9:366-381. [PMID: 33042640 PMCID: PMC7540615 DOI: 10.1055/s-0040-1710560] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 04/13/2020] [Indexed: 10/23/2022]
Abstract
In the last two decades, surgeons have rapidly developed arthroscopic techniques to treat basal joint osteoarthritis. Such techniques spare the joint capsule and ligaments, allow more accurate staging of cartilage degeneration to determine the most appropriate treatment, and decrease the risk of injury to the radial artery and superficial branch of the radial nerve. Arthroscopic resection arthroplasty of the trapezium can be performed as either partial or complete trapeziectomy. Many papers have described partial trapeziectomy but few have discussed complete trapeziectomy. Suture button implants avoid the drawbacks of temporary fixation using Kirschner wire, as well as the drawbacks of ligament reconstruction, which necessitates the sacrifice of a tendon and involves both wide exposure and scar tissue. This paper aimed to review the published data on the arthroscopic treatment of basal thumb osteoarthritis, with a special focus on stabilization using suture button suspensionplasty, and to present a technique that structures this procedure into three steps, allowing it to be performed in an easier, more organized, and faster way.
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Affiliation(s)
- Fernando Corella
- Department of Orthopedic and Trauma, Hospital Universitario Infanta Leonor, Madrid, Spain
- Hand Surgery Unit, Hospital Universitario Quironsalud Madrid, Madrid, Spain
- Department of Surgery, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Montserrat Ocampos
- Department of Orthopedic and Trauma, Hospital Universitario Infanta Leonor, Madrid, Spain
- Hand Surgery Unit, Hospital Universitario Quironsalud Madrid, Madrid, Spain
| | - Rafael Laredo
- Hand Surgery Unit, Hospital Universitario Quironsalud Madrid, Madrid, Spain
- Hand Surgery Unit, Department of Orthopedic and Trauma, Virgen de la Salud University Hospital, Madrid, Spain
- Department of Orthopedic and Trauma, Quironsalud Toledo, Toledo, Spain
| | - José Tabuenca
- Department of Orthopedic and Trauma, Hospital Universitario Quironsalud Madrid, Madrid, Spain
| | - Maribel Carnicer
- Department of Orthopedic and Trauma, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Ricardo Larrainzar-Garijo
- Department of Orthopedic and Trauma, Hospital Universitario Infanta Leonor, Madrid, Spain
- Department of Surgery, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Assess the patient's history, clinical examination, and radiographic findings to diagnose and stage basilar joint arthritis. 2. Recall the cause and epidemiology of the condition. 3. Formulate a management plan including nonoperative management, and evaluate the candidacy for surgical treatment. 4. Understand the rationale for the various surgical options available (including rehabilitation), their potential complications, and the evidence related to outcomes. SUMMARY This article has been prepared to accompany practice-based assessment with ongoing surgical education for the Maintenance of Certification for the American Board of Plastic Surgery. It is designed for clinicians to analyze and structure their care of a patient with arthritis of the trapeziometacarpal joint.
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Vitale MA, Hsu CC, Rizzo M, Moran SL. Pyrolytic Carbon Arthroplasty versus Suspensionplasty for Trapezial-Metacarpal Arthritis. J Wrist Surg 2017; 6:134-143. [PMID: 28428915 PMCID: PMC5397306 DOI: 10.1055/s-0036-1593735] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 09/06/2016] [Indexed: 12/28/2022]
Abstract
Purpose This study aims to compare outcomes after pyrolytic carbon implant hemiarthroplasty (PH) versus Thompson suspensionplasty (TS) for trapezial-metacarpal (TM) arthritis. Patients and Methods There were 87 arthritic TM joints in 71 patients treated with PH (n = 47 joints, 37 patients) or TS (n = 40 joints, 34 patients). Patients had significantly longer follow-up in the TS group (86.9 months, 25th-75th percentile = 55.6-103.8) versus the PH group (38.4 months, 25th-75th percentile = 23.2-65.8, p < 0.001). Results PH patients maintained higher final grip strength (p = 0.03) and apposition pinch strength (p = 0.01) compared with TS patients. Nelson scores were significantly higher among patients undergoing PH (mean = 50.4, standard deviation [SD] = 24.5) compared with TS (mean = 36.8, SD = 12.5, p < 0.01). There was a significantly higher proportion of complications (p < 0.01), reoperations (p < 0.01), and joint revision surgery (p < 0.01) in patients undergoing PH compared with TS. Controlling for age and sex, there was a 72.8% lower risk of complications (p = 0.02), 87.7% lower risk of reoperations (p = 0.01), and 87.2% lower risk of joint revision surgery (p < 0.01) among patients undergoing TS compared with PH. There was a shorter time to first complication (p < 0.01), reoperation (p < 0.02), and joint revision (p < 0.01) in those undergoing PH compared with TS. Conclusion Both cohorts exhibited functional range of motion and pinch and grip strengths postoperatively, and those undergoing PH began with and maintained higher grip and pinch strength at final follow-up. Those undergoing PH had significantly increased risk of complications, reoperations, and joint revision surgery. Most complications in patients undergoing PH were related to suspected development of scaphotrapezotrapezoidal (STT) arthritis postoperatively. We thus recommend careful evaluation of possible STT arthritis when considering PH arthroplasty. Level of Evidence Level III.
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Affiliation(s)
- Mark A. Vitale
- ONS Foundation for Clinical Research and Education, Greenwich, Connecticut
| | - C. C. Hsu
- Division of Hand Surgery and Plastic Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Marco Rizzo
- Division of Hand Surgery and Plastic Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Steven L. Moran
- Division of Hand Surgery and Plastic Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Vitale MA, Taylor F, Ross M, Moran SL. Trapezium prosthetic arthroplasty (silicone, Artelon, metal, and pyrocarbon). Hand Clin 2013; 29:37-55. [PMID: 23168027 DOI: 10.1016/j.hcl.2012.08.020] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Trapezium prosthetic arthroplasty has been utilized to treat basal joint arthritis for nearly five decades in an attempt to mitigate some of the potential disadvantages of trapeziectomy while preserving range of motion. Implant arthroplasty seeks to preserve joint biomechanics, avoids metacarpal subsidence, and should provide immediate stability. These benefits may lead to improvements in strength, durability, and a decrease in metacarpophalangeal joint hyperextension which can occur subsequent to metacarpal shortening. First generation implants were primarily silicone trapezial spacers. While the use of these implants has been curtailed by their association with silicone synovitis, they still remain an option for low demand, rheumatoid patients. More recently developed synthetic spacers such as Artelon interposition arthroplasties have had results inferior to more established procedures including trapeziectomy. A variety of metal total joint prostheses have been developed and some of the more recent designs have shown good short-term outcomes. There are a number of different pyrocarbon implants that have become more recently available which range from trapezial substitution to non-anatomic hemiarthroplasty. Pyrocarbon arthroplasty offers a number theoretical advantages however early results have been mixed and further long term data is required.
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Affiliation(s)
- Mark A Vitale
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
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