Six year outcome excision of the trapezium for trapeziometacarpal joint osteoarthritis: is it improved by ligament reconstruction and temporary Kirschner wire insertion?

Abstract

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.

Degenerative Change at the Pseudarthrosis After Trapeziectomy at 6-year Followup

“…However, we are not aware of any studies that have assessed the pseudarthrois gap at longer followup after simple excision of the trapezium. Previous longer-term followup studies of this procedure have exclusively assessed the clinical outcome [13,14,21]. Our finding is particularly interesting because a Kirschner wire was not inserted during the simple trapeziectomy to hold the thumb metacarpal base away from the distal pole of the scaphoid during the immediate postoperative period.…”

“…In the original study, the clinical outcomes at 1 and 6 years were assessed [8,21]. Three of these assessment methods were the Patient Evaluation Measure (PEM) score [19], the Disabilities of the Arm, Shoulder and Hand (DASH) score [16], and thumb key pinch strength, and these data were used in the present study.…”

“…This study used men and women recruited during 2002 to 2005 to a randomized controlled study [8,21], which compared the 1-and 6-year outcomes of excision of the trapezium alone (without temporary Kirschner wire support) and excision of the trapezium with LRTI using 50% of the flexor carpi radialis tendon and temporary Kirschner wire support [4] for trapeziometacarpal joint osteoarthritis [8,21]. That study had ethical committee approval from Nottingham Research Ethics Committee 2 (Ref.…”

“…Recent research suggests construction of a suspensory ligament may not improve the outcome of trapeziectomy at 1 year [7,8,12,23] or 5 or more years [13,21] followup. However, there is still concern that, at longer followup, recurrent thumb pain and loss of function may occur after trapeziectomy without ligament reconstruction or tendon interposition as a result of the development of degenerative osteoarthritis at the articulation between the thumb Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.…”

Editorial

“…Trapezectomy is an established surgical treatment (Salem and Davis, 2012). Although most patients achieve good pain relief, their pinch strength typically remains weak.…”