Natural History of Metacarpal Subsidence following Trapeziectomy and Its Relationship to Clinical Outcomes

Arthroscopic Total Trapeziectomy for Thumb Carpometacarpal Arthrosis

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.