Clinical and radiological outcomes of the Ivory arthroplasty for trapeziometacarpal joint osteoarthritis with a minimum of 5 years of follow-up: a prospective single-centre cohort study

We present the results of a 5 year prospective follow-up study on the functional outcome after total replacement of the trapeziometacarpal joint with the Ivory prosthesis (Memometal, Stryker Corporate, Kalamazoo, Michigan, USA) in 22 patients. The female to male ratio was 21:1 and the mean age was 66 (range 54-78) years. The mean follow-up period was 67 (range 60-77) months after operation. Patient satisfaction was high. The mobility of the operated thumb was restored to a range of motion comparable to the contralateral thumb. Key pinch and grip strength improved by 13% and 31%, respectively. Overall function, according to Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, improved by 59%. Pain decreased by 85% according to the numerical rating scale. Radiological evaluation revealed no loosening of the implant after 5 years except in one patient who required revision due to polythene wear with secondary joint instability. Another patient had asymptomatic polythene wear that required no revision but remains in follow-up. The 5 year overall survival of the prosthesis was 95%. These medium-term results suggest that the Ivory arthroplasty is a reliable option for treating advanced trapeziometacarpal arthritis, because it appears to give a very good functional outcome and has the potential for long-term survival rates.

Correlation of clinical disease severity to radiographic thumb osteoarthritis index

PURPOSE

To determine if a slight modification of the 1987 Eaton-Glickel staging and interpreting 4 standardized radiographs for trapeziometacarpal (TMC) osteoarthritis (OA) improved analysis, to determine if a quantifiable index measurement from a single Robert (pronated anteroposterior) view enhanced reproducibility, and to examine whether improved radiographic staging correlated to clinically relevant disease and thus support validity.

METHODS

We analyzed 4 thumb radiographs (posteroanterior, lateral, Robert, and stress views) in 60 consecutive subjects representing an adult population spectrum of asymptomatic to advanced disease. Two experienced hand surgeons (A.L.L. and A.P.C.W.), 1 chief resident (A.J.B.), and 1 medical student (J.M.M.) performed the analysis on each subject's radiographs. We analyzed all 4 radiographs for Eaton and modified Eaton staging and then later analyzed only the Robert view for the thumb osteoarthritis (ThOA) index measurement. The radiographs were randomized and reread a week later for each classification at separate times. Surgically excised trapeziums from 20/60 subjects were inspected for first metacarpal surface disease and correlated to the 3 classifications.

RESULTS

All 3 staging classifications demonstrated high reproducibility, with the intraclass correlation coefficient averaging 0.73 for the Eaton, 0.83 for the modified Eaton, and 0.95 for the ThOA index. Articular wear and metacarpal surface eburnation correlated highest to the ThOA index, with advanced disease 1.55 or greater correlating to Eaton III/IV and modified Eaton stage 3/4 in a linear relationship.

CONCLUSIONS

The ThOA index based on a Robert view provided a measurable alternative to Eaton staging and correlated to severity of surgically relevant thumb TMC OA.

CLINICAL RELEVANCE

A simple reproducible radiographic measurement may enhance TMC OA classification and provide a reliable means to predict clinical disease.

TYPE OF STUDY/LEVEL OF EVIDENCE

Diagnostic II.

Psychological differences between patients that elect operative or nonoperative treatment for trapeziometacarpal joint arthrosis

Among 44 consecutive patients electing operative treatment of trapeziometacarpal arthrosis, three age- and gender-matched controls that presented during the same time period but had not yet requested operative treatment were selected from billing records. Each patient and control was mailed a survey that included an upper extremity-specific health status measure (Disabilities of the Arm, Shoulder, and Hand questionnaire; DASH) and a set of questionnaires evaluating psychological factors including the Pain Anxiety Symptoms Scale (PASS), the Pain Catastrophizing Scale (PCS) and the Center for the Epidemiological Study of Depression (CES-D) instrument. Seventy-two patients (45%; 31 that elected operative and 41 nonoperative care) returned a completed questionnaire with usable data. Older age was the only significant predictor of choice for nonoperative treatment among survey responders. Arm-specific disability (DASH) correlated with the CES-D, PASS, and PCS scores, and the influence of radiographic severity was near significant (p = 0.06). Stepwise multiple linear regression resulted in a model including the CES-D and PCS scores and accounting for 51% of the variability in DASH scores for patients from both cohorts. For both the operative and nonoperative cohorts, a model including CES-D alone accounted for 50% of the variability in DASH scores (p < 0.01). This study suggests that depression, pain anxiety, and pain catastrophizing are strong correlates of arm-specific disability but do not predict election of operative treatment in patients with trapeziometacarpal arthrosis.

Decision Aid for Trapeziometacarpal Arthritis: A Randomized Controlled Trial

PURPOSE

Decision aids increase patient participation in decision making and reduce decision conflict. The goal of this study was to evaluate the effect of a decision aid prior to the appointment, upon decisional conflict measured immediately after the visit relative to usual care. We also evaluated other effects of the decision aid over time.

METHODS

In this randomized controlled trial, we included 90 patients seeking the care of a hand surgeon for trapeziometacarpal (TMC) arthritis for the first time. Patients were randomly assigned to receive either usual care (an informational brochure) or an interactive Web-based decision aid. At enrollment, consult duration was recorded, and patients completed the following measures: (1) Decisional Conflict Scale; (2) Quick Disabilities of Arm, Shoulder, and Hand (QuickDASH); (3) pain intensity; (4) Physical Health Questionnaire (PHQ-2); (5) satisfaction with the visit; and (6) Consultation And Relational Empathy (CARE) scale. At 6 weeks and 6 months, patients completed: (1) pain intensity measure; (2) Decision Regret Scale; and (3) satisfaction with treatment. We also recorded changes in treatment and provider.

RESULTS

Patients who reviewed the interactive decision aid prior to visiting their hand surgeon had less decisional conflict at the end of the visit. Other outcomes were not affected.

CONCLUSIONS

Use of a decision aid prior to a first-time visit for TMC led to a measurable reduction in decision conflict. Decision aids make people seeking care for TMC arthritis more comfortable with their decision making. Future research might address the ability of decision aids to reduce surgeon-to-surgeon variation, resource utilization, and dissatisfaction with care CLINICAL RELEVANCE: Surgeons should consider the routine use of decision aids to reduce decision conflict.

Pyrocarbon interposition (PyroDisk) implant for trapeziometacarpal osteoarthritis: minimum 5-year follow-up

PURPOSE

To report outcomes after a minimum of 5 years following pyrocarbon interposition (PyroDisk) trapeziometacarpal joint implant for osteoarthritis at a single center.

METHODS

We retrospectively reviewed the midterm clinical and radiological outcomes of 19 patients who had a pyrocarbon interposition implant (PyroDisk; Integra Life Sciences, Plainsboro, NJ) arthroplasty. The rate and causes of repeat surgeries, revisions, and complications were examined.

RESULTS

The mean follow-up period was 68 months. Patient satisfaction was high. The mobility of the operated thumb was restored to a range of motion comparable with that of the contralateral thumb. Grip strength improved by 26%. Overall function, according to the Quick Disabilities of the Arm, Shoulder, and Hand score, showed an average improvement of 71 to 20. Pain decreased by 78% according to the numerical rating scale. Radiological evaluation using a modification of the system described by Herren revealed progression of the periprosthetic lucency (grade I-II) of the implant after 5 years in 5 of 19 (26%) patients. Progression of lucency did not predict implant loosening or failure at 5 years. Two patients had symptomatic instability that required revision. No dislocations occurred. The 5-year survival of the prosthesis was 90%.

CONCLUSIONS

The PyroDisk implant for treating advanced trapeziometacarpal arthritis did not demonstrate superiority over published outcome data of trapeziectomy with or without ligament reconstruction and tendon interposition.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Outcomes of Revisions for Failed Trapeziometacarpal Joint Arthritis Surgery

PURPOSE

We compare outcomes of revision surgery for trapeziometacarpal (TM) arthritis with outcomes for both primary and revision surgery for TM arthritis reported in the literature. We hypothesized that patients undergoing revision surgery for TM arthritis would demonstrate pain and functional outcome scores that were worse than those of patients undergoing primary TM surgery.

METHODS

A retrospective analysis of all patients undergoing revision TM surgery at a single institution from 1995 to 2015 was performed. Eighty-three patients (86 hands) met the inclusion criteria. Of these, 25 patients (27 hands) were available for follow-up via phone survey or clinical examination; 58 patients (59 hands) were available for chart review only. Patients available for phone survey or clinical examination were evaluated with the visual analog scale, Disabilities of the Arm, Shoulder, and Hand score, and the Conolly-Rath evaluation method. Patients available for clinical examination were also evaluated with grip strength, pinch strength, and radiographs.

RESULTS

Median follow-up was 8.5 years (range, 2.0-21.2 years). Twenty percent of patients experienced postoperative complications, most commonly pin problems (7%). Of the 27 hands available for interview or clinical examination, 15 were dominant and 12 were nondominant. The average visual analog scale was 28.2 (SD, 29.7). Disabilities of the Arm, Shoulder, and Hand scores averaged 32.0 (SD, 20.8). According to the Conolly and Rath criteria, 10 patients had a good outcome, 7 were fair, and 10 were poor. For the group of 13 patients who underwent physical examination, average adduction was 42° in the affected side versus 51° in the nonaffected side. Radial abduction was 58° in the affected side versus 65° in the nonaffected side. Palmar abduction was 53° versus 85° in each group, respectively. Tip finger pinch was 3.4 kg for the affected hand versus 4.0 kg for the nonaffected side. Key pinch was 4.7 and 5.5 kg, respectively. Grip strength was measured as 22.1 kg in the affected side versus 27.6 kg in the contralateral side when adjusted for dominance.

CONCLUSIONS

In our study group, revision surgery for unsuccessful primary TM surgery demonstrated results inferior to those previously reported for primary surgery for TM arthritis but similar to prior studies of revision TM surgery. Revision surgery, however, can result in satisfactory long-term outcomes particularly when metacarpophalangeal joint pathology is addressed and complications are avoided.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Trapeziectomy with LRTI or joint replacement for CMC1 arthritis, a randomised controlled trial

We compared an uncemented joint replacement (Elektra) with trapeziectomy (with ligament reconstruction and tendon interposition, LRTI) for the treatment of primary osteoarthritis in the first carpometacarpal joint (CMC1) in a randomised controlled trial. Forty patients were included (20 in each group) and followed for 2 years. The median age in the groups was 64 and 61, respectively, with 14 females in each. At final follow-up, there was no difference in the primary outcome measure (the quick disabilities of the arm, shoulder and hand score, QDASH), but the joint replacement group had significantly better motion and strength during the early rehabilitation period and significantly better range of thumb abduction and extension at the last follow-up. There were more complications in the joint replacement group with revision of prosthetic components in five cases, two of them due to cup loosening. Radiologically, lucency zones were seen around either cup or stem in 15 patients. Most were small, but two cases with major osteolysis resulted in revision. Shortening of the thumb ray was observed after trapeziectomy.

Unplanned Reoperation After Trapeziometacarpal Arthroplasty: Rate, Reasons, and Risk Factors

BACKGROUND

Trapeziometacarpal (TMC) arthritis is an expected part of ageing to which most patients adapt well. Patients who do not adapt to TMC arthritis may be offered operative treatment. The factors associated with reoperation after TMC arthroplasty are incompletely understood. The purpose of this study was to determine the rate of, the underlying reasons for, and the factors associated with unplanned reoperation after TMC arthroplasty.

METHODS

In this retrospective study, we included all adult patients who had TMC arthroplasty for TMC arthritis at 1 of 3 large urban area hospitals between January 2000 and December 2009. Variables were inserted into a multivariable Cox proportional hazards model to determine factors associated with unplanned reoperation, and the Kaplan-Meier curve was used to estimate and describe the probability of unplanned reoperation over time.

RESULTS

Among 458 TMC arthroplasties, 19 (4%) had an unplanned reoperation; 16 of 19 (84%) for persistent pain and two-thirds within the first year. The multivariate Cox regression analysis showed that unplanned reoperation was independently associated with younger age, surgeon inexperience, and index procedure type.

CONCLUSIONS

Surgeons should be aware as well as patients should be informed that as many as 4% are offered or request a second surgery, usually for persistent pain and often within the 1-year window when additional improvement is anticipated.

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.

Medium to Long-Term Follow-Up After Pyrocarbon Disc Interposition Arthroplasty for Treatment of CMC Thumb Joint Arthritis

PURPOSE

Pyrocarbon disc interposition arthroplasty has been designed for the surgical treatment of Eaton-Glickel grade II/III carpometacarpal thumb joint arthritis. This study presents the results of this technique with a minimum 5-year follow up.

METHODS

We assessed 4 questionnaires for patient-reported outcome measurements in a cross-sectional study: the Patient-Rated Wrist and Hand Evaluation, Disabilities of Arm, Shoulder, and Hand questionnaire, Michigan Hand Questionnaire, and questions about satisfaction at the 5-year follow up. We evaluated grip and pinch strength, range of motion, and the radiological position of the disc. Finally, a Kaplan-Meier survival analysis was performed.

RESULTS

A total of 164 thumbs (in 137 patients) were available for follow-up varying from 5 to 12 years. Median Patient-Rated Wrist and Hand Evaluation, Disabilities of Arm, Shoulder, and Hand, and Michigan Hand Questionnaire scores were 17, 18, and 76, respectively. The satisfaction score was 9 (Likert scale of 1-10). Grip and pinch strength reached nearly 100% compared with the contralateral hand. Range of motion resulted in a Kapandji score of 10. Thumb height showed a marginal loss and the Kaplan-Meier survival curve showed a survival rate of 91%.

CONCLUSIONS

Our study suggests that pyrocarbon disc interposition arthroplasty is a reliable and feasible treatment for carpometacarpal thumb joint arthritis at medium-term follow-up. It was associated with a high level of patient satisfaction; it maintained thumb height and the implant survived in 91% of patients. Strength and range of motion were comparable to the contralateral hand after a minimum follow-up of 5 years.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Outcomes of Surgical Management for Thumb Basilar Arthritis in Patients 55 Years of Age and Younger

Background: Trapeziectomy with ligament reconstruction tendon interposition (LRTI) or suspensionplasty is an effective treatment in older patients with end-stage thumb basilar arthritis. However, the survivability of this procedure is unknown in younger patients who may impart more stress on their thumbs. Methods: A retrospective review was performed on all patients who underwent trapeziectomy and LRTI or suspensionplasty at 55 years of age or younger from 1992 to 2008. Objective clinical outcome measures included preoperative to postoperative changes in thumb range of motion, grip and pinch strength, a study-specific thumb function score, and the Buck-Gramcko subjective outcome score. Progressive metacarpal subsidence was evaluated on radiographs. Survivorship free from revision surgery was calculated with a Kaplan-Meier analysis. Results: A total of 57 wrists underwent trapeziectomy and LRTI (n = 18) or suspensionplasty (n = 39). The mean patient age at the time of surgery was 49.6 years (range: 38-55 years). Mean clinical and radiographic follow-up were 10.2 and 6.4 years, respectively. Overall, there were significant improvements in pain and grip strength despite progressive and metacarpal subsidence. Survivorship was 100% and 86% free from revision surgery at 10 and 15 years, respectively (n = 2 failures). Conclusions: Trapeziectomy and LRTI or suspensionplasty in patients less than or equal to 55 years of age can result in considerable improvements in pain and grip strength with a 10-year survivorship free from revision.

Anatomic variations of the first extensor compartment and abductor pollicis longus tendon in trapeziometacarpal arthritis

Anatomic variation of the trapeziometacarpal joint stabilizing structures is one of the concepts proposed to explain the pathogenesis of trapeziometacarpal arthritis. We undertook this study to test the hypothesis that septation of the first extensor compartment or variation of the abductor pollicis longus (APL) tendon (supernumerary insertions) are more frequently associated with the progression or severity of trapeziometacarpal arthritis. Septation within the first extensor compartment was significantly associated with trapeziometacarpal arthritis (p = 0.013), whereas supernumerary APL insertions (trapezium or thenar) did not reveal a significant association (p = 0.811 and p = 0.937, respectively). The results of this study do not support a role for variations of APL tendon insertions in trapeziometacarpal arthritis. Yet, the presence of septation within the first extensor compartment may play an important role in the pathogenesis of trapeziometacarpal arthritis.

Radial Column Excision and Four-Corner Fusion for the Treatment of Basal Thumb Arthritis and Scapholunate Advanced Collapse Wrist or Midcarpal Arthritis

Background  The combination of trapeziometacarpal arthritis and intercarpal pattern of degenerative wrist arthritis is uncommon. Purpose  To report on the clinical and radiologic results of patients who have undergone radial column excision (scaphoidectomy and trapeziectomy) (RCE) and four-corner fusion (4CF). We describe the patterns of disease that present with basal thumb and midcarpal arthritis and treatment outcomes of a single-surgeon series. Patients and Methods  A consecutive series of seven patients underwent RCE and 4CF over a 2-year period, for basal thumb osteoarthritis with concurrent degenerative midcarpal wrist arthritis. Six patients were available for review. All six patients were women with a mean age of 73 years (range: 67-78; SD 4.6). Mean follow-up time was 48.2 months (34-59 months). Radiographic and clinical outcomes were recorded for all patients, to include wrist range of motion, key pinch, grip strength, and patient-rated wrist evaluation (PRWE). Results  There were no failures or revision procedures. The mean range of motion was flexion of 40 degrees (range: 30-40 degrees), extension of 30 degrees (range: 20-42 degrees), radial deviation of 18 degrees (range: 10-30 degrees), and ulnar deviation of 15 degrees (range: 0-25 degrees). The mean key pinch was 4.2 kg (range: 0.5-10, SD ± 3.5) and mean grip strength was 9.4 kg (range: 0-19, SD ± 8.9). The PRWE results in four patients were within normal values. Conclusion  RCE with 4CF resulted in acceptable clinical outcomes in four of six patients treated, with no failures at a mean follow-up of 48.2 months. Level of Evidence  Level IV, therapeutic study.

Minimal clinically important difference of the Trapeziometacarpal Arthrosis Symptoms and Disability questionnaire

III.

Effect of Trapeziectomy on Carpal Stability

Background: The scaphoid-trapezoid-trapezium (STT) articulation stabilizes the scaphoid and links the proximal and distal carpal rows. The purpose of the study was to determine whether trapezium excision in the treatment of trapeziometacarpal (TM) arthritis affects carpal stability. Methods: A retrospective chart and radiographic review was performed on all wrists that underwent trapeziectomy with suspensionplasty or ligament reconstruction, and tendon interposition for TM arthritis between 2004 and 2016. Radiographic outcome measures included the modified carpal height ratio (MCHR) and radioscaphoid (RS), radiolunate (RL), and scapholunate (SL) angles. Degenerative change at the TM and STT joints was classified according to the Eaton-Littler, and Knirk and Jupiter classification systems. Radiographic parameters were compared between preoperative and final follow-up time points. Results: A total of 122 wrists were included in the study with a mean follow-up of 3.5 years (range: 1.0-13.0 years). The mean RL (range: -2.2° ± 11.8° to -10.7° ± 16.5°) and RS angles (range: 52.6° ± 13.8° to 44.4° ± 17.8°) decreased significantly (<.001) without significant change in SL angle, indicating progressive lunate and scaphoid extension after trapeziectomy. The mean MCHR decreased significantly (range: 1.6 ± 0.1 to 1.5 ± 0.1) following trapeziectomy, indicating progressive carpal collapse. Progressive scaphoid-trapezoid arthrosis was observed following trapeziectomy. No other preoperative radiographic factors investigated were associated with significant differences in preoperative and postoperative values for radiographic outcome measures. Conclusions: Trapeziectomy can lead to loss of carpal height, coordinated extension of both the lunate and scaphoid, and progressive scaphotrapezoid arthrosis. As such, in wrists with dynamic or static carpal instability, trapeziectomy should be performed with caution due to the risk of carpal collapse with a nondissociative pattern of dorsal intercalated segment instability.

Trapeziometacarpal Joint Arthrodesis Using a Cannulated Compression Screw and Locking Plate Construct

Background: Trapeziometacarpal (TMC) arthrodesis is an established surgical option for the treatment of basal joint osteoarthritis. It has traditionally been indicated in younger, higher demand patients who would benefit from the increased strength afforded by a stable thumb base. Trapeziometacarpal arthrodesis has a higher reported complication rate than other treatment options, including nonunion and symptomatic hardware. Description of Technique: We describe a novel construct for TMC joint arthrodesis using a cannulated headless screw to compress the arthrodesis site and a low-profile locking plate to neutralize the considerable musculotendinous forces crossing the joint. Patients and Methods: We performed a retrospective review of 10 patients treated with this fusion construct between June 2019 and February 2021. Results: The average patient age was 56.5 years; 7 patients were female and 3 were male. The mean pain score, on a 0 to 10 point scale, decreased from 7.2 preoperatively to 1.6 at final postoperative follow-up. All patients achieved bony union; none underwent removal of hardware. Conclusions: Given the high reported rate of nonunion following TMC arthrodesis in the literature, improvements in surgical technique are needed. In a small cohort of patients, we report favorable outcomes with a new technique for TMC arthrodesis.

Combined Treatment of Trapeziometacarpal Joint Arthritis and Scapholunate Advanced Collapse Wrist

PURPOSE

The combined treatment of trapeziometacarpal joint arthritis and scapholunate advanced collapse (SLAC) wrist presents unique challenges. The consequences of the loss of radial column support caused by scaphoidectomy and trapeziectomy are not well known. The purpose of this study was to evaluate the outcomes of the simultaneous and staged treatment of trapeziometacarpal joint arthritis and SLAC wrist.

METHODS

A retrospective review of patients who underwent surgery for both trapeziometacarpal joint arthritis and SLAC wrist was performed. The wrist and thumb range of motion; grip and pinch strength; pain; quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores; and radiographs were analyzed.

RESULTS

Twenty-four patients who underwent both trapeziectomy and 1 of 3 procedures for SLAC wrist (4-corner fusion [n = 10]), proximal row carpectomy [n = 9], and total wrist arthroplasty [n = 5]) in a single stage (n = 10) or in 2 stages (n = 14) were included. The median age was 63 years. The median follow-up period was 35 months. Twelve (50%) patients underwent complete scaphoidectomy, and 12 (50%) patients underwent partial scaphoidectomy. All 3 procedures resulted in an improvement in pain at rest, pain during activity, and quick Disabilities of the Arm, Shoulder and Hand scores. The final range of motion, grip and pinch strength, and complication rates were consistent with those reported in the literature for isolated procedures.

CONCLUSIONS

Trapeziometacarpal joint arthritis and SLAC wrist may be treated either simultaneously or in stages.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic V.

Effect of Tendon Strip (FCR vs APL) on Outcome of CMC Thumb Joint Arthroplasty With Pyrocarbon Disk Interposition

BACKGROUND

Pyrocarbon disk interposition for carpometacarpal (CMC) thumb joint osteoarthritis can be performed with a flexor carpi radialis (FCR) or abductor pollicis longus (APL) tendon strip. With the FCR technique, a ligament reconstruction is performed in addition to disk fixation, whereas with the APL technique the disk is simply secured in place. Our aim is to compare long-term postoperative outcomes between both techniques.

METHODS

In this observational study, we included 106 patients in 2 centers operated on between 2006 and 2011. We assigned patients to the FCR group or the APL group based on the respective tendon strip used. As a primary outcome, we analyzed postoperative key pinch. In addition, we analyzed postoperative tip pinch and tripod pinch, grip strength, range of motion, thumb height maintenance, and patient-reported outcome measures (PROMs).

RESULTS

The analysis showed clinically important stronger key pinch for the APL group (β = 1.28 kg). Tip pinch and grip strength showed higher outcome for the FCR group (β = 1.22 kg and 5.14 kg, respectively). Palmar abduction was in favor of the FCR group and opposition in favor of the APL group, but these were interpreted as not clinically relevant. Radiological thumb height maintenance and PROMs showed no clinical difference.

CONCLUSIONS

Pyrocarbon disk interposition arthroplasty for CMC thumb joint osteoarthritis can be secured with an APL or FCR tendon strip. At long-term follow-up, use of an APL tendon strip results in significantly higher key pinch and better opposition. Tip pinch, grip strength, and palmar abduction were better after use of the FCR tendon strip. The choice of the tendon strip can be based on outcomes considered most important for the individual patient.

Outcomes of Secondary Trapeziectomy Following Carpometacarpal Pyrocarbon Prosthetic Arthroplasty

PURPOSE

Pyrocarbon implant hemiarthroplasty is a treatment option for select patients with trapeziometacarpal joint arthritis. The long-term revision rates after implant arthroplasty can be as high as 30%. Revision to trapeziectomy has been described for patients who require implant removal; however, few studies have assessed outcomes in patients in this subgroup.

METHODS

This was a retrospective review of patients who underwent the conversion of a pyrocarbon carpometacarpal implant to trapeziectomy and suspensionplasty from 2003 to 2019. Patients who met the criteria were then compared with a matched cohort who underwent primary trapeziectomy and suspensionplasty. Patients were matched based on the revision procedure, age, and duration of follow-up. Data regarding demographic information, range of motion, grip and pinch strengths, and the need for subsequent procedures were collected.

RESULTS

Twenty-five patients underwent the removal of their pyrocarbon carpometacarpal implant. The patients underwent revision to Thompson suspensionplasty (n = 14), the Weilby procedure (n = 5), ligament reconstruction tendon interposition (n = 2), or a suture-based suspension procedure (n = 4). The age, sex, and preoperative range of motion and strength measures were similar between the 2 groups. All the patients complained of moderate-to-severe pain prior to surgery, which improved in both groups after surgery. Patients who underwent the removal of a pyrocarbon arthroplasty implant lost 6.4° of palmar abduction after surgery. The postoperative grip, opposition strength, apposition pinch strength, and radial and palmar abduction were similar between the 2 groups.

CONCLUSIONS

The removal of a pyrocarbon carpometacarpal implant using subsequent trapeziectomy successfully relieves pain in patients in whom pyrocarbon arthroplasty has failed. After revision, patients may lose abduction motion but have similar strength compared with those who undergo primary trapeziectomy.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic III.

Dorsoradial Ligament Reconstruction in Trapeziometacarpal Joint Arthritis

BACKGROUND

The main purpose of the study is to present the alternative novel surgical technique in treating patients with trapeziometacarpal (TMC) joint arthritis using dorsoradial ligament (DRL) reconstruction technique and report the clinical outcomes.

METHODS

Patients who were diagnosed with TMC joint arthritis and underwent DRL reconstruction were evaluated. Visual analog pain score; Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score; grip, tip pinch, tripod pinch, and key pinch strengths along with range of motion of the thumb; and Kapandji score were recorded in the preoperative period and at follow-up. Stress examination was also performed under a fluoroscope.

RESULTS

Eleven patients were included in the study. Median follow-up time was 13 months. At follow-up, postoperative visual analog scale and QuickDASH score improved in all patients. Grip, tip pinch, tripod pinch, and key pinch strengths also improved. The range of motion and Kapandji score were slightly improved compared with the preoperative period except for the thumb metacarpophalangeal flexion. Two patients had numbness at the thumb and spontaneously recovered after 3 months.

CONCLUSIONS

According to recent evidence which proposed the importance of DRL in TMC joint stability, our DRL reconstruction technique may be an alternative treatment in treating patients presented with TMC joint arthritis. Further study with a longer follow-up period is needed.