This randomized prospective study compared the treatment of trapeziometacarpal joint osteoarthritis with a) trapeziectomy with no ligament reconstruction, no soft tissue interposition and no temporary Kirschner wire stabilization (Group T); b) trapeziectomy with flexor carpi radialis ligament reconstruction and interposition and temporary K-wire stabilization (Group T+LRTI). We followed 99 patients with 114 thumbs (59 T and 55 T+LRTI) for a mean of 6.2 (range, 4.2-8.1) years. There were no significant differences between the two treatments in any subjective or objective outcome measure at 6 year follow-up. Eighty-two percent of the thumbs were painless or only ached after use. The DASH (Group T mean, 31; 95% CI, 26-42: Group T+LRTI mean 30; 95% CI, 22-35) and Patient Evaluation Measure (Group T mean, 35; 95% CI, 29-41: Group T+LRTI mean 34; 95% CI, 27-39) scores were significantly better than preoperatively. Thumb key pinch strength did not differ significantly between the two treatment groups (Group T mean 3.7 kg: 95% CI, 3.3-4.2: Group T+LRTI mean 4.1 kg, 95% CI, 3.7-4.7) and was not significantly different from the preoperative key pinch strength. This study does not provide evidence to support the use of LRTI and temporary K-wire stabilization after trapeziectomy.
Surgical decompressions for CSM stop the progress of symptoms at 12 months post-surgery and may result in a significant improvement of NMG in two-thirds of the patients. Changes in the T1-weighted MRI images predict worse outcomes following surgery.
Background Simple trapeziectomy has a well-documented history of success for the management of osteoarthritis at the trapeziometacarpal joint. There is concern, however, that late-onset failure can occur as a result of the development of degenerative disease at the scaphoid-metacarpal pseudarthrosis. Questions/purposes The purpose of this study was to determine whether (1) radiographic changes of degenerative joint disease progressed; (2) the pseudarthrosis height diminished between 1 year and 6 years after either simple trapeziectomy or trapeziectomy with ligament reconstruction and tendon interposition (LRTI); and 3) the presence of degenerative changes were associated with inferior scores on standardized outcomes instruments. Methods Using cases from an earlier randomized trial, the 1-year and 6-year stress radiographs of the pseudarthrosis between the distal pole of the scaphoid and the base of the thumb metacarpal were assessed for degenerative change in 25 thumbs that had undergone simple excision of the trapezium and 29 that had undergone trapeziectomy + LRTI for painful trapeziometacarpal joint osteoarthritis. Degenerative change was graded according to a Kellgren and Lawrence system, and clinical results were assessed using the Patient Evaluation Measure (PEM), Disabilities of the Arm, Shoulder and Hand (DASH) questionnaires, and thumb key pinch strength. Results One of the 29 thumbs treated with trapeziectomy + LRTI and seven of the 25 thumbs treated by simple excision of the trapezium exhibited increased degenerative change at their final followup. A pseudarthrosis space was preserved in 22 of the 25 simple trapeziectomies and 28 of the 29 trapeziectomies + LRTI. The presence of degenerative change did not adversely affect the outcome as measured by the PEM, the DASH, or thumb key pinch strength. Conclusions Increased degenerate-like changes were observed after simple excision of the trapezium but these did not influence the clinical outcome. Level of Evidence Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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