Arthroplasty for Trapezium Excision and Tendon Interposition in Rhizarthrosis Cases: Prospective Study

Abstract

Objective: To prospectively evaluate the results from a series of patients who underwent surgical treatment for rhizarthrosis using the technique of trapezium resection associated with interposition of yarn from the long abductor tendon of the thumb. Methods: From May to August 2005, ten patients underwent surgical treatment for rhizarthrosis. Patients with primary osteoarthrosis of the trapezium-metacarpal joint, in stages II, III and IV of the Eaton classification, with persistent pain that was refractory to clinical treatment, were included. For the functional assessment, the visual analogue scale, DASH questionnaire and Buck-Gramcko score were used. For the overall assessment on the patients, strength measurements were made for palm grip, pulp to pulp pinch, lateral pinch, three-point pinch, opposition and radial and palmar abductions. The migration index for the first metacarpal was also determined on radiographs at rest and under stress. Results: The pain relief was considered to be good (p = 0.005), with functional improvements in modules 2 (p = 0.02) and 3 (p = 0.022) of DASH. The Buck-Gramcko score showed one excellent and three very good results. There was an improvement in almost all of the overall assessment and was only non-significant regarding lateral pinch and abduction. For all patients, there was migration of the first metacarpal. Conclusion: Trapeziectomy associated with interposition of yarn from the long abductor tendon of the thumb was shown to be a relatively simple and effective technique for pain relief and functional improvement.

Simplified abductor pollicis longus suspension interposition arthroplasty for thumb carpometacarpal joint osteoarthritis

“…Junior et al evaluated the results of ten patients using a technique of APL interposition arthroplasty with temporary Kirschner wire fixation followed up over a mean period of 41.6 months. The VAS measured 7.77 before surgery and 2.04 after surgery [20]. Nanno The pain at rest was 6.7 ± 1.9 preoperatively versus 1.1 ± 1.7 postoperatively [8,22,23].…”

“…Junior et al evaluated the results of ten patients using a technique of APL interposition arthroplasty with temporary Kirschner wire fixation followed up over a mean period of 41.6 months. The VAS measured 7.77 before surgery and 2.04 after surgery [ 20 ]. Nanno et al investigated the clinical results of 16 patients who were treated with a modified Thompson procedure with a mean follow-up of 25 months.…”

“…Restoration of near full mobility with stability of the ray is a relevant indicator for the constitution of the suspension. In the study of Junior et al, radial and palmar abduction presented significant improvements after the operation from 30.2° to 40.3° and 32° to 39.5° [ 20 ]. Nanno et al evaluated the average radial and palmar abduction with 30.9° and 36.5° before surgery and 54.1° and 48.9° after surgery.…”

“…In the study of Junior et al, the tip pinch strength presented significant improvement after surgery from 3.3 to 5.5 kg. The grip strength decreased significantly from 18.2 to 11.3 kg [ 20 ]. Nanno et al showed that average pinch tip and grip strength markedly improved from 3.43 kg and 13.3 kg before surgery to 4.61 kg and 18.8 kg after surgery [ 21 ].…”

“…Given that most surgical techniques have a high success rate, perhaps the most important part of articles describing procedures should be a discussion of complications. Junior et al evaluated four patients with temporary dysaesthesia of the dorsoradial region of the thumb and one patient with early loosening of the Kirschner wires [ 20 ]. In the study by Rab et al, no complications occurred [ 22 ].…”