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

Abstract

Numerous surgical procedures have been described to treat trapeziometacarpal osteoarthritis, but no approach is currently considered superior. Good long-term outcomes have been reported with multiple procedures. No studies have been published comparing outcomes of the Arpe joint replacement (Biomet, Valence, France) with those of ligament reconstruction and tendon interposition (LRTI) using the Burton-Pellegrini technique. The study objective was to compare clinical outcomes between these techniques. Sixty-five patients with Eaton stage III osteoarthritis of the thumb were included in this retrospective follow-up study. Patients were assigned to LRTI (LRTI group) or total joint replacement (Arpe group) and were followed for a mean of 4.8 years. The LRTI group included 34 patients and the Arpe group included 31. Clinical outcome variables were determined preoperatively and every 6 months postoperatively. Pain relief and functional improvement were similar between groups. Pinch strength and range of motion were superior in the Arpe group. Metacarpophalangeal hyperextension appeared to be prevented in the Arpe group but increased over the follow-up period in the LRTI group. However, the complication rate was higher in the Arpe group. Arthroplasty with the Arpe prosthesis can be considered in selected patients who require greater strength and range of motion, although it has been associated with a higher complications rate. [Orthopedics. 2017; 40(4):e681-e686.].

Total arthroplasty with Ivory® prosthesis versus resection–suspension arthroplasty: a retrospective cohort study on 82 carpometacarpal-I osteoarthritis patients over 4 years

“…These advantages of prosthesis may result from a more anatomical reconstruction of the thumb MC joint. Other comparative studies corroborate our findings and even present better results in every performance parameter for prosthesis implantation [2,11,12]. Cebrian-Gomez et al also included Ivory prosthesis patients in their comparative survey with a comparable clinical follow-up period.…”

“…Few studies have compared CMC-I protheses to RA [2,11,12]. Therefore, the aim of this retrospective study was to conduct a mid-term comparison between patients who had undergone Ivory prothesis implantation and RA.…”

Metacarpophalangeal Arthrodesis with Resection-suspension Arthroplasty in First Carpometacarpal Osteoarthritis

“…2,5 Pero también se sabe que cuando se realiza una resección del trapecio (asociando o no la suspensión del primer metacarpiano) la hiperextensión MCF puede empeorar al disminuir la altura de la columna del pulgar. 3 Esto no sucede si tratamos la rizartrosis con una prótesis TMC, puesto que no se reduce la altura del pulgar coloca una prótesis TMC. 6 La hiperextensión MCF sola o asociada con el choque entre el primer MC contra el remanente carpiano es causa de revisión de la trapecectomía.…”

“…1,2 No tratar adecuadamente la articulación MCF cuando se reseca el trapecio puede ocasionar un empeoramiento de la función de la mano y provocar una reintervención. 3 El objetivo del estudio es conocer si el tratamiento quirúrgico simultáneo de ambas articulaciones consigue un resultado clínico y funcional adecuado a medio plazo.…”

Trapeziometacarpal Joint: A Mechanical Explanation of Total Prosthesis Failures

“…With the usual ball-and-socket design, patients obtain faster and better pain relief, stronger grip function, and shorter convalescence than with trapeziectomy [8,9]. However, there are also many reports of poor results [10]. Revisions are most often due to the loosening of the trapezium cup [11,12] and of the metacarpal stem and to the luxation of the first metacarpal bone [13] (Figure 3).…”