Aims

The objective of this systematic review was to describe trapeziectomy outcomes and complications in the context of osteoarthritis of the base of the thumb after a five-year minimum follow-up.

Purpose

Osteoarthritis of the trapezio-metacarpal joint (TMJ or basal thumb joint) is a common condition causing significant disability. A range of non-operative and operative management options can be used for its treatment. One of the most common conservative treatments is a steroid injection into the joint. To confirm correct placement of the steroid it is preferable to use X-ray image intensification. Few previous studies have audited effectiveness, particularly with the use of radiological guidance.

Trapeziometacarpal arthritis is a common condition, causing symptoms in up to ten percent of women and one percent of men¹. LRTI is the most commonly used surgical technique for this condition however, long-term studies have shown persistent weakness of pinch strength² after surgery. The Ascension® PyroDisk is a pyrocarbon disk shaped implant designed to articulate against the trapezium and metacarpal, preserving the height of the articulation. The objective of this study was to determine whether treatment with a pyrocarbon implant resulted in comparable pain relief and range of motion, whilst providing superior gains in pinch strength when compared to LRTI.

This is a prospective randomized control trial comparing pyrocarbon implant to LRTI. Surgeries were accomplished by a single surgeon in a standardized fashion. Patients were evaluated at six weeks, three, six and 12 months following surgery. Data on pain (VAS), function (Patient Rated Wrist Evaluation (PRWE)), mobility and strength (grip, key and lateral pinch) were obtained as well as radiographic assessment of the height of the arthroplasty space.

A total of 80 patients had surgery between July 2008 and November 2016. Forty patients were allocated to the PyroDisk group and 40 to the LRTI group. Seventy-four patients (92,5%) completed the one year follow-up. Mean age was slightly older in the PyroDisk group (64 vs 60,8 y.o., p=0,03). Surgical and tourniquet times were longer in the PyroDisk group. There was no difference between the groups in strength, pain or functional outcome at one year. However, VAS was significantly higher in the PyroDisk group at three and six months (4,5 vs 2,4, p < 0,001, 2,6 vs 1,7, p=0,02) and PRWE was also significantly better at three months in the LRTI group (53,7 vs 71,2, p=0,02). The overall complication rate was three times higher in the PyroDisk group (10% vs 30%).

Treatment of trapeziometacarpal arthritis with PyroDisk does not provide superior functional gains when compared to LRTI. On the contrary, it seems to result in more pain in the first few months following surgery. This difference in pain is not seen at 1 year after surgery. This may suggest that there is a period of adaptation to the Pyrodisk after its insertion. We also found a higher risk of complications with the use of the PyroDisk.

The June 2015 Wrist & Hand Roundup360 looks at: Collagenase and Dupuytren’s disease – a genuine alternative to surgery?; iPad PROMise?; Should we learn how to do endoscopic carpal tunnel release?; Two-week radiographs a relic of the past?; Bible? Aspirate or excise?; Patient expectations and trapeziometacarpal osteoarthritis; Splintage in the treatment of sagittal band incompetence and extensor tendon subluxation

The June 2012 Wrist & Hand Roundup. 360. looks at; radial osteotomy and advanced Kienböck's disease; fixing the Bennett fracture; PEEK plates and four-corner arthrodesis,;carpal tunnel release and haemodialysis; degloved digits and the reverse radial forearm flap; occupational hand injuries; trapeziometacarpal osteoarthritis; fixing the fractured metacarpal neck and pyrocarbon implants for the destroyed PIPJ

This retrospective study evaluated 69 Swanson trapezium replacements performed between 1990 and 2009 for trapeziometacarpal osteoarthritis in 58 patients. Pain and function were assessed using the Michigan Hand Questionnaire (MHQ) and the Disability of the Arm, Shoulder and Hand (DASH) questionnaire. Patients had a mean age of 62 years at the time of surgery, with a mean time of 7.7 years from time of surgery to completion of the follow-up interview. The results showed good relief of pain and function with no significant deterioration with time from surgery. There were no gender differences or differences by age. The only differences observed were that those patients following surgery on a dominant hand indicated higher activities of daily living and work related activities. The authors conclude silicone trapezium replacement remains a good option for patients with painful trapeziometacarpal osteoarthritis that has not responded to non-operative treatment

Objectives: Evaluation of patients satisfaction, radiological and functional outcome in patients with trapeziometacarpal osteoarthritis after trapeziectomy with a extensor carpi radialis longus suspension. Material and Methods: Between November 1997 and Dezember 2003, 44 patients (34 female, 10 male, average age 60 years, range 46 to 73 years) underwent trapeziectomy with extensor carpi radialis longus suspension at our institution. In 37 patients clinical and radiological outcome could be assessed after an average follow up of 7 years (range 5 to 10 years). 7 patients were lost to follow up. Preoperative range of motion, pain intensity (VAS) function and radiographs were evaluated. Postoperative patients satisfaction, using the DASH score functional and radiological outcome was determined. Results: The average patients satisfaction was 27.8 points (range 0 – 70). Pain intensity improved from pre-operative VAS 8.5 (range 6.3 – 10) to postoperative 1.9 (range 1.2 to 4). 92 % of patients would again choose this surgical procedure. Duration of pain anamnesis was 24 months or longer in 64% of patients. After 3 months full pain relief and usage property was achieved in 62% of patients. A free opposition was possible in 76%, radial abduction of 40° was possible in 24%, of 30–40° in 38% and of 20–30° in 35% of patients. Palmar abduction of more than 40° was possible in 68% and 30 – 40° in 32% of patients. Grip strength deteriorated in 49%, in 16% there was no difference and improved in 35% compared to the other hand. The average trapezium space lost 18% of its height compared with preoperative values. Conclusion: Trapeziectomy with extensor carpe radialis longus suspension shows good results regarding pain relief but remarkable deterioration of strength

Introduction: The surgical gold standart treatment of the thumb osteoarthritis is the trapeziectomy with tendon interposition and ligament reconstruction. The trapeziometacarpal prosthesis is an option badly estimated in the literature. Between 1994 and 2001, 43 non-cimented trapeziometacarpal prosthesis ARPE® (Biomet. ™. ) was implanted by the same operator for isolated trapezio-metacarpal degenerative osteoarthritis. The minimal follow-up is 5 years. The aim of this study is to evaluate the fonction of the thumb with a 5 year-old or more trapeziometacarpal prosthesis. The technique is described and the revisions are analysed. Material and methods: 33 women and 2 men, mean age 59,4-years, were operated after failure of the conservative treatment. There are 7 lost sight (9 prosthesis) and 2 deaths (2 prosthesis). 27 other patients (32 prostheses) were examined by the author with an original revision questionnary associated to the score of DASH. The average follow up for the 25 prosthesis always implanted is 86 months. 7 revisions (16%) were necessary on average after 34 months (1 month in 10 years) : 5 for loosenning, 1 for premature dismantling and 1 for recurrent partial dislocation. 6 were treated by trapeziectomy with tendinous interposition of palmaris longus according to the technique of F.E. Jones. Results: The mobility is perfect for all patients but one. There is no tendancy for the cup or steem to sink into the bone but there is often some medial calcifications around the trapezium. Average DASH score is 27.4/100. There is no infection and only one dislocation at 1 months (reduction by closed procedure). The survival of the prosthesis is 85% in 5 years. In the first 13 months, 4 revisions is necessary. The ablation of the cup is easy but the extraction of de metacarpal still is often difficult. The scaphometacarpal height is constantly lowered (34,5 % on average). Aesthetically, 2 patients are disappointed and preferred their thumb with prosthesis. Discussion and conclusion: The prosthesis ARPE ® is an effective option in this series for the treatment of the degenerative trapeziometacarpal osteoarthritis but its radioclinic control is necessary for the first year

The December 2014 Wrist & Hand Roundup360 looks at: ultrasound for carpal tunnel diagnosis; where we are at with management of undisplaced scaphoid fractures; ARPE for thumb metacarpals?; extravasation injuries in the hand and wrist; research and practice in hand surgery; and physio ineffective in hand osteoarthritis