Surgical Treatment of Trapeziometacarpal Joint Arthritis: A Historical Perspective

Abstract

Background The trapeziometacarpal (TMC) joint's unique anatomy and biomechanics render it susceptible to degeneration. For 60 years, treatment of the painful joint has been surgical when nonoperative modalities have failed. Dozens of different operations have been proposed, including total or subtotal resection of the trapezium or resection and implant arthroplasty. Proponents initially report high levels of patient satisfaction, but longer-term reports sometimes fail to support initial good results. To date, no one procedure has been shown to be superior to another. Questions/purposes This review sought to identify factors responsible for the development of many different procedures to treat the same pathology and factors influencing whether procedures remain in the armamentarium or are abandoned.

Management of Osteoarthrosis of the Thumb Joints

“…One can argue that, as long as this is achieved, further surgical interventions may be considered superfluous until proven otherwise by properly designed randomized trials. 50 We believe that simple trapeziectomy with HDA is as effective as more complicated procedures. 21 Although it seems unsettling to remove the trapezium and not fill the void, the body has remarkable capacities of self-healing.…”

Developments in trapezium replacements

“…More recently, with the advancement of small joint implant material technology, several pyrocarbon implant models have been introduced. 10 Woodward et al . describe the practical and theoretical benefits and drawbacks of pyrocarbon implants compared to traditional trapeziectomy, including improved range of motion, decreased postoperative pain and stiffness, and earlier recovery of strength, as well as an increased risk of subluxation of the implant.…”

“… 9 However, there is no current consensus that implant arthroplasty provides superior pain reduction or improved function compared to simple resection arthroplasty. 10 …”

Current trends in the management of trapeziometacarpal arthritis

“…found that the 60-yearold procedure of simple trapezial resection remains the most common surgical procedure for trapeziometacarpal (TMC) joint arthritis, while newer soft tissue and prosthetic arthroplasty methods have not shown any conclusive superiority in terms of pain reduction or increased function. 2 This is in sharp contrast with surgical treatments for other arthritic joints, which have largely evolved from resection arthroplasty to implant arthroplasty. 2 …”