Arthroscopy-assisted partial trapeziectomy combined with ligament reconstruction for thumb carpometacarpal joint osteoarthritis: A different technique

Abstract

BackgroundThere is no consensus on the best surgery option for thumb carpometacarpal osteoarthritis (CMC OA). The traditional method has the risk of large trauma, obvious metacarpal subsidence, and decreased stability. The aim of this study is to introduce a different technique to restore the function and stability of the first carpal metacarpal joint with minimal trauma, rapid pain relief, reduced complications, and the clinical outcomes in the long-term follow-up was evaluated and statistically analyzed.MethodsThis was a retrospective study of 10 patients with a mean age of 51.8 years. The surgery consisted of removing partial trapezium through arthroscopy, reconstructing the stability with flexor carpi radialis suspension and tendon interposition. The subjective assessment included visual analog scale (VAS) of pain, quick disabilities of the arm, shoulder, and hand (Quick-DASH) score, and patient satisfaction. The range of motion, grip strength, pinch strength, and radiographic assessment, which can reflect stability of the thumb, were objectively evaluated and statistically analyzed.ResultsTen patients were monitored at a mean follow-up of 6.8 years. The mean grip strength improved significantly from 16.64 to 22.57 kg after surgery. Pinch strength improved significantly from 3.72 to 5.71 kg on average. The Kapandji score improved significantly from 5.7 to 8.6 on average. 80% (8/10) of the patients were satisfied with this surgery. On objective indicators, the VAS score decreased significantly from 6.4 to 1.3 on average. The mean Quick-DASH score improved significantly from 6.1 to 28.9. Postoperative x-ray showed slight subsidence and dislocation of the first metacarpal in two patients and did not affect the function by measurement.ConclusionArthroscopy-assisted partial trapezium resection combined with ligament reconstruction could be a workable and promising surgical technique in patients with thumb CMC OA. It can offer the advantages of minimizing surgical injury by preserving the first carpal metacarpal joint capsule to protect its stability, with a rapid pain relief, function improvement, and satisfactory results in patients’ clinical measurements.

Effectiveness of Arthroscopic Debridement, Trapeziectomy, and Joint Replacement for Trapeziometacarpal Joint Osteoarthritis: A Meta-Analysis of Pre and Postoperative Pain Scores

“…However, the mean follow-up duration was 15 months for the AD group and 14 months for the TRAP group. The present study demonstrates that at longer follow-up durations, up to 81.6 months in the AD group and 46.6 months in the TRAP group, there are insignificant changes in pain scores postoperatively between the two procedures [ 25 , 30 ]. This observation suggests that while TRAP may offer superior short-term pain relief, the long-term efficacy in terms of pain reduction appears to converge between the two treatments.…”

“…This indicates clinically significant pain reduction, even though initial pain levels were mild across different stages of arthritis [ 27 ]. Zheng et al reported 10 patients with mixed stages of arthritis and substantial pain relief from an average of 6.4 preoperatively to 1.1 postoperatively [ 30 ]. However, Pereira et al’s study contradicted the above arthroscopy results with a high failure rate and conversion to TRAP when arthroscopic intervention was done in the advanced stages of arthritis [ 31 ].…”

“…There were 763 patients in total, of whom 102 (13%) underwent AD, 428 (56%) underwent TRAP, and 233 (31%) underwent JR. Only one study [15] in this meta-analysis was a randomized control trial (RCT); six studies [16][17][18][19][20][21] were retrospective cohort studies, six were prospective cohort studies [22][23][24][25][26][27], four studies were case series [28][29][30][31], and one study was case-control [32]. Three studies reported on both JR and TRAP, allowing us to analyze both datasets separately in our meta-analysis [24][25][26].…”

“…After categorizing the studies based on distinct surgical interventions, we identified five groups for AD, 13 for TRAP, and six for JR, resulting in 24 distinct groups for our analysis. In the AD groups, one group performed arthroscopic carpometacarpal (CMC) joint synovectomy and joint debridement [32], while three groups utilized AD with partial TRAP [23,27,30]. In the JR groups, diverse techniques and implants were employed; each group utilized a unique prosthesis [17,21,[24][25][26]28].…”