Long term outcome of trapeziectomy with ligament reconstruction/tendon interposition versus thumb basal joint prosthesis

Abstract

Several surgical techniques to treat thumb basal joint arthritis have been described. In this study we compared the results of a cemented thumb basal joint with trapeziectomy with a ligament reconstruction and tendon interposition. A questionnaire was sent to all 519 patients, 322 (with 382 procedures) responded. No significant differences were found when comparing impairment, pain, patient satisfaction and disability. Given the fact that the superiority of a prosthesis cannot be proven and the cost of the implant is greater, we recommend the trapeziectomy with ligament reconstruction and tendon interposition as opposed to arthroplasty as the first choice in the treatment of basal joint osteoarthritis of the thumb.

Trapeziectomy With Ligament Reconstruction and Tendon Interposition Versus a Trapeziometacarpal Prosthesis for the Treatment of Thumb Basal Joint Osteoarthritis

“…Ulrich-Vinther et al 20 reported no cases of prosthesis dislocation and found no differences between groups in complication rates. Vandenberghe et al 21 and De Smet et al 22 did not study the presence of complications during the follow-up. However, dislocation is a severe complication that usually requires revision surgery, increasing patient discomfort and costs, and it can be avoided by selecting other procedures such as trapeziectomy, with or without LRTI or trapeziometacarpal arthrodesis.…”

“…[3][4][5][6][7][8][9][10][11][12][14][15][16][17][18][19] A prospective study of 98 patients by Ulrich-Vinther et al 20 compared Elektra prosthesis (Fixano, Péronnas, France) with LRTI using the Sigfusson and Lundborg technique at 1 year postoperatively and reported faster and better pain relief, stronger grip function, greater range of motion, and lesser convalescence time with the trapeziometacarpal joint prosthesis than with the tendon interposition arthroplasty. Vandenberghe et al 21 and De Smet et al 22 compared the long-term outcomes between cemented trapeziometacarpal prosthesis (De la Caffinière; Howmedica, Newbury, United Kingdom; and Roseland; DePuy) and LRTI (Burton-Pellegrini technique) in retrospective studies of 519 and 55 patients, respectively, after a mean follow-up of 5.4 and 9 years, respectively, based on the same initial series of patients. They found no differences in pain relief or functional improvement between the techniques.…”

Osteoarthritis and prosthetic joints in the hand

“…33,34 Arthroscopic debridement with interposition or distraction arthroplasty have been reported to produce good short-term outcomes. CMC fusion can reliably relieve pain, and has the advantage of maintaining pinch strength but at the cost of higher risk of complications, stiffness of the thumb and the potential for degenerative changes in adjacent joints.…”

“…33 On the back of the success of hip arthroplasty there was a wave of enthusiasm for metalloplastic articulations and a number of ball and socket designs were introduced for MCP joint and even the PIP joint. At the base of the thumb excision arthroplasty remains the 'gold standard' against which the success of alternative interventions must be judged.…”

The Trapeziometacarpal Arthrosis Symptoms and Disability Questionnaire

“…In addition, the Nelson Hospital Score has poor methodological quality, 31 lacks factor analysis to confirm the number of factors (subscales) and related items, and has rarely been used. 12,14,15,38 A TMC joint-specific questionnaire might be more responsive (able to detect clinically important change but distinguish it from measurement error) than a hand or upper extremity questionnaire. 31 Furthermore, a TMC joint-specific questionnaire might also help discriminate symptoms and disability related to TMC arthrosis from symptoms and disability due to other hand, arm, or shoulder problems.…”