Trapeziectomy for Trapeziometacarpal Joint Osteoarthritis: Is Ligament Reconstruction and Temporary Stabilisation of the Pseudarthrosis with a Kirschner Wire Important?

Abstract

This randomised prospective study compared two operations for trapeziometacarpal joint osteoarthritis: trapeziectomy with Flexor carpi radialis ligament reconstruction, tendon interposition and Kirschner wire insertion followed by splintage for 6 weeks (T+LRTI) and excision of the trapezium with no Kirschner wire and immobilisation of the thumb in a soft bandage for only 3 weeks (T). Sixty-seven thumbs with trapeziectomy (T) and 61 with trapeziectomy and ligament reconstruction and tendon interposition (T+LRTI) were assessed preoperatively and at 3-months and 1-year after surgery. Forty-seven percent and 73% of patients reported no pain or only aching after use at 3-months and 1-year respectively and the DASH and Patient Evaluation Measure (PEM) outcome scores reduced postoperatively indicating improved function. However the pain, DASH and PEM scores, and also key and tip thumb pinch and all the other clinical outcome measures, did not differ significantly between the two groups at either 3-months or 1-year after surgery.

A Systematic Review of Postoperative Hand Therapy Management of Basal Joint Arthritis

“…In studies in which patients underwent trapeziectomy followed by either tendon interposition or ligament reconstruction, the duration of splinting or casting ranged from 4 to 8 weeks. A common theme in studies in which a Kirschner wire was used after the surgical procedure [3,6,14,15] was that patients were casted or splinted at least until the wire was removed, which occurred 4 to 5 weeks after surgery. For the studies in which some sort of joint prosthesis was implanted [1,9,18,20,21,24], postoperative immobilization time ranged from 2 to 6 weeks.…”

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

“…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.…”

“…The entry criteria were painful trapeziometacarpal joint osteoarthritis, which had not responded to nonoperative treatment. The operative techniques and postoperative rehabilitation used in this study have previously been described [8]. Ninety-nine patients recruited into this study (114 thumbs) had undergone stress radiographs of the thumb at both their 1-year and 6-year (median, 6 years; range, 5-8 years) postoperative assessments.…”

“…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.…”