Trapeziometacarpal narrow pseudarthrosis: a new surgical technique to treat thumb carpometacarpal joint arthritis

Abstract

We describe a technique that arose from the observation of the clinical outcome of failed arthrodeses of the thumb carpometacarpal joint. In these cases a pseudoarthrosis developed which, surprisingly, rarely lead to a poor clinical outcome. Thus we developed a simple technique which deliberately caused the formation of a narrow pseudoarthrosis in the carpometacarpal joint. We present a retrospective review of 248 consecutive patients treated for Eaton stages II and III osteoarthritis. We observed a statistically significant improvement in mean appositional and oppositional pinch strength, mean DASH score (63.8 pre-operatively to 10.5 at final follow-up), and the mean pain score (8.3 to 0.2). We conclude that trapeziometacarpal limited excision arthroplasty is a simple and reliable alternative to existing surgical techniques for treating Stage II or III thumb carpometacarpal joint arthritis.

Trapeziometacarpal arthrodesis: is bone union necessary for a good outcome?

“…The most important conclusion from our series, is that the subjective and objective variables did not correlate with bone union across the thumb CMC joint. In addition the patients with a 'narrow pseudoarthrosis' had a lower incidence of STT joint arthritis, confirming the hypothesis of Rubino et al (2013) who did not find any deterioration of the STT joint in their series. Damen et al (2001) noted that, in their patients treated with thumb CMC joint arthrodesis, the radiographic progression and severity of STT arthritis were greater in the fused thumb than in the contralateral thumb.…”

“…A recent study has developed a new surgical technique that aims to create a narrow CMC pseudoarthrosis to transform the joint from a synovial diarthrodial joint into a fibrous joint (Rubino et al, 2013). Good results are reported suggesting that a fibrous non-union may provide a satisfactory result.…”

Interposition Arthroplasty Versus Hematoma and Distraction for the Treatment of Osteoarthritis of the Trapeziometacarpal Joint

“…10) By observing the good clinical outcome of a failed arthrodesis of the thumb carpometacarpal joint, recently some authors have shown good results by deliberately creating a narrow pseudoarthrosis in the TM joint, although this is not recommended for stage IV. 11) TM joint arthroplasty is another option which aims at preserving the length of the thumb with soft tissue balancing but this technique is weighted down by its high rate of complications, such as radiographic subsidence into the trapezium, bone loosening, migration and dislocation, especially when using Moje Acamo CMC 1 implants and Elektra and Pyrocarbon implants. [12][13][14][15] Good results were presented by Goubau et al 16) after joint replacement with ivory prosthesis (Memometal, Stryker Corporate) in 22 patients included in a 5-year prospective follow-up study.…”

Nonunion Following Trapeziometacarpal Arthrodesis With Plate and Screw Fixation

“…3 Rubino et al reported that patients with nonunion after arthrodesis only complain of pain until the metalwork has been removed. 4 This suggests that the retained hardware may be the source of pain. Patients with nonunion can have persistent pain and weakness with activities even when hardware is not present, however.…”

“…4 Of these 5 patients, one patient (20%) had a nonunion and underwent revision arthrodesis with plates and iliac crest bone graft. This failed to unite, and was again revised with tensionband wiring and bone grafting resulting in union.…”