Survival and Long-Term Outcomes of Thumb Metacarpal Extension Osteotomy for Symptomatic Carpometacarpal Laxity and Early Basal Joint Arthritis

Bachoura, Abdo; Yakish, Eric J; Lubahn, John D.

doi:10.1016/j.jhsa.2018.01.005

Cited by 14 publications

(30 citation statements)

References 20 publications

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“…The authors reported satisfying clinical results for their patients [ 5 ]. Other studies also supported those first data, which have recently been extended to include long-term results [ 6 – 12 ].…”

Section: Introductionsupporting

confidence: 58%

Precision of the Wilson corrective osteotomy of the first metacarpal base using specific planning and instruments for treatment of basal thumb arthritis

Kriechling

Reissner

Zindel

et al. 2022

Arch Orthop Trauma Surg

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Introduction Arthritis of the basal thumb is a relatively common condition also affecting younger patients. Wilson et al. described a 20°–30° closing wedge osteotomy of the first metacarpal bone to unload the trapeziometacarpal joint. It was the purpose of this study to analyze the clinical and radiographic outcome of patients who underwent proximal extension osteotomy of the first metacarpal bone using patient-specific planning and instruments (PSI). Methods All patients who underwent proximal metacarpal osteotomy for basal thumb arthritis at our tertiary referral center were retrospectively included. The patients underwent preoperative planning using computed tomography and 3D segmentation to build patient-specific guides and instruments for the operative treatment. Stable fixation of the osteotomy was achieved by internal plating. The inclusion criterion was a minimum follow-up of 1 year with clinical examination, including the Michigan Hand Outcomes Questionnaire (MHQ), and computed tomography to validate the correction. Complications and reinterventions were recorded. Results A total of eight Wilson osteotomies in six patients could be included at a mean follow-up duration of 33±16 months (range, 12 to 55 months). The patients were 49±8 years (range, 36 to 58 years) at the surgery and 88% were female. The postoperative MHQ for general hand function was 77±8 (range, 45 to 100) and the MHQ for satisfaction was 77±28 (range, 17 to 100). The working status was unchanged in 7/8 hands (6/7 patients). Radiographic analysis revealed successful correction in all cases with unchanged Eaton–Littler stage in 7/8 hands. No complications were recorded. Conclusion The combined extending and ulnar adducting osteotomy using patient-specific guides and instrumentation provides an accurate treatment for early-stage thumb arthritis. Level of evidence Type IV—retrospective, therapeutic study.

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Section: Introductionsupporting

confidence: 58%

Precision of the Wilson corrective osteotomy of the first metacarpal base using specific planning and instruments for treatment of basal thumb arthritis

Kriechling

Reissner

Zindel

et al. 2022

Arch Orthop Trauma Surg

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“…Thirty-two procedures in 7 males and 21 females were performed (mean age, 44.8 y). Overall, thumb metacarpal osteotomy provided some degree of pain relief and improvement of function [30].…”

Section: Discussionmentioning

confidence: 96%

“…Likewise [30] evaluated the survival and long-term outcomes of thumb metacarpal extension osteotomy for early CMC arthritis. Patients who underwent a thumb extension osteotomy between years 2000 and 2011 were identified.…”

Section: Discussionmentioning

confidence: 99%

Operative Treatment for First Carpometacarpal Arthritis ( Systematic Review )

Zahed

Ahmed

Farag

et al. 2021

Benha Journal of Applied Sciences

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The anatomy of the thumb carpometacarpal (CMC) joint, as well as the force transmitted through it, makes it extremely susceptible to osteoarthritis (OA). The thumb CMC joint has been reported as the most painful joint when compared to other hand joints affected by OA. to provide an updated, systematic review of surgical management and outcomes of the most commonly used surgical procedures to treat CMC joint OA presented in literature. we searched Medline via PubMed, SCOPUS, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar from their inception till January, 36 studies were included. the overall effect estimates showed that the rate of pain at rest after metacarpal osteotomy was 25.1% (95% CI 9.6 -40.7%); while the rate of satisfaction after metacarpal osteotomy was 48.1% (95% CI 10.5 -85.7%). The overall effect estimates showed that the rate of normal handgrip after metacarpal osteotomy was 87.1% (95% CI 79.2 -95%). the overall effect estimates showed that the rate of pain at rest after Volar ligament reconstruction was18.4% (95% CI 11.5 -25.4%) and the rate of satisfaction was 81.6% (95% CI 74.6 -88.5%). no surgical procedure appears to be definitely superior to another for the management of first carpometacarpal arthritis in terms of pain, physical function, patient global assessment, range of motion, or strength. Nevertheless, participants who had trapeziectomy had fewer complications than those who had the other commonly used procedures analyzed in the review.

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“… 19 , 20 In a follow-up review of 13 patients, Chou et al 21 found that 77% of patients were satisfied or very satisfied at a mean follow-up of 9.9 years (range, 6–14 years). Bachoura et al 22 found that 7 of 32 operated thumbs (22%) required reoperation. Kaplan-Meier analysis of this series indicated a 70% probability that patients who had an extension osteotomy would not require additional CMC surgery for up to 14 years.…”

Section: Discussionmentioning

confidence: 98%

Bone-Preserving Arthroplasty With Abductor Pollicis Longus Tenodesis for Trapeziometacarpal Osteoarthritis

Thiele

Mauler

Fuhrer

et al. 2021

Journal of Hand Surgery Global Online

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The objective of this study was to describe an original method of bone-preserving arthroplasty with abductor pollicis longus (APL) tenodesis and determine its safety and effectiveness as a treatment for early-stage osteoarthritis of the trapeziometacarpal joint. Methods: Eleven patients underwent a trapezium-preserving arthroplasty with APL tenodesis for stage 1 and 2 osteoarthritis were retrospectively reviewed. This arthroplasty consisted of a distally-based APL tendon being passed through the trapeziometacarpal joint. The proximal end of the tendon was then pulled and passed through a drill hole made at the neck of the second metacarpal and sutured to itself. Thus, distraction of the first metacarpal and interposition of the tendon were created. Postoperative radiologic and clinical follow-up visits were performed at 4, 8, and 12 weeks. Range of motion and strength were assessed after surgery. Patient satisfaction and outcome were assessed, and the disabilities of the arm, shoulder, and hand (DASH) score was used. Results: After a mean follow-up of 29.5 months (range, 16e43 months), the mean patient visual analog scale pain score improved from 7.1 to 2.3. The average DASH score of all patients at the follow-up examination was 18.3 ± 19.8. Patients' mean grip strength was 25.3 kg, which represented 102% of the value on the contralateral side. The key-pinch strength was 6.2 kg on the operated hand compared with 6.5 kg on the contralateral side. The mean thumb opposition Kapandji index was 9.4, which was similar to that of the contralateral side. Three patients were very satisfied with the postoperative outcome and 3 patients were satisfied. Two patients were lost to follow-up, 1 patient did not consent to share her data, and 2 patients had to undergo trapeziectomy. Conclusions: Although a larger study population and a longer follow-up period are needed to draw conclusions, bone-preserving arthroplasty with APL tenodesis showed satisfying results in patients presenting with early-stage osteoarthritis. This method is technically simple and time-efficient, does not reduce the range of motion, and leaves open all other surgical options. Type of study/level of evidence: Therapeutic, Level IV, Case Series.

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Survival and Long-Term Outcomes of Thumb Metacarpal Extension Osteotomy for Symptomatic Carpometacarpal Laxity and Early Basal Joint Arthritis

Abstract: Therapeutic IV.

Cited by 14 publications

References 20 publications

Precision of the Wilson corrective osteotomy of the first metacarpal base using specific planning and instruments for treatment of basal thumb arthritis

Precision of the Wilson corrective osteotomy of the first metacarpal base using specific planning and instruments for treatment of basal thumb arthritis

Operative Treatment for First Carpometacarpal Arthritis ( Systematic Review )

Bone-Preserving Arthroplasty With Abductor Pollicis Longus Tenodesis for Trapeziometacarpal Osteoarthritis

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