Abstract
Background
A randomised prospective study has already demonstrated that at 1-year follow-up, palmaris longus interposition or flexor carpi radialis (FCR) ligament reconstruction and tendon interposition do not improve the outcome of trapeziectomy for the treatment of painful osteoarthritis of the trapeziometacarpal joint. This study consisted of 183 thumbs in 162 women.
Aims
114 of the 183 thumbs have now completed their 5-year follow-up and this study reports their results.
Patients and methods
The patients had been prospectively randomised for treatment by simple trapeziectomy without interposition or ligament reconstruction (T; n=45), trapeziectomy with palmaris longus interposition (T+PL; n=31) or ligament reconstruction and tendon interposition (T+LRTI; n=38) using 50% of the FCR tendon. Each patient had undergone assessments of thumb pain, stiffness and strength pre-operatively, at 3 months, at 1 year and after a minimum of 5 years post-operatively.
Results
The three treatment groups were well matched for age and hand dominance. At the 5 year follow-up, 76% (T=80%; T+PL=71%; T+LRTI=76%) of the 114 patients had no pain or only mild pain after use. Thumb key pinch strengths at the 5 year follow-up did not differ significantly between the three procedures [T= 4.0 kg (95%CI, 3.6-4.4); T+PL= 3.6 kg (95%CI, 2.9-4.3); T+LRTI= 3.6 kg (95%CI, 3.1-4.1)]. The tip pinch strengths at 5 years were also similar after each of the operations [T= 2.7 kg (95%CI, 2.4-2.9); T+PL= 2.4 kg (95%CI, 1.9-2.9); T+LTRI= 2.5 kg (95%CI, 2.1-2.9)]. No cases of late deterioration were evident at 5 years.
Conclusion
The outcomes of these three variations of trapeziectomy appear identical. Thus at 5 years, there appears to be no benefit to tendon interposition or ligament reconstruction.
