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Comparative Study
. 2007 Aug;31(4):547-54.
doi: 10.1007/s00264-006-0217-5. Epub 2006 Sep 22.

Long term results of surgical intervention for osteoarthritis of the trapeziometacarpal joint : comparison of resection arthroplasty, trapeziectomy with tendon interposition and trapezio-metacarpal arthrodesis

E E J Raven  1 , G M M J Kerkhoffs, S Rutten, A J W Marsman, R K Marti, G H R Albers
Affiliations
Comparative Study

Long term results of surgical intervention for osteoarthritis of the trapeziometacarpal joint : comparison of resection arthroplasty, trapeziectomy with tendon interposition and trapezio-metacarpal arthrodesis

E E J Raven et al. Int Orthop. 2007 Aug.

Abstract
in English, French

Trapeziometacarpal osteoarthritis is a common entity, often bilateral and predominantly affecting postmenopausal women. In the case of failure of conservative treatment, surgery is a good option. The aim of this study was to compare three surgical procedures. 63 patients (74 thumbs) with osteoarthritis of the trapezio-metacarpal joint were surgically treated; 54 patients were seen for follow-up, 7 had died and 2 were lost to follow-up. The patients were stratified according to treatment; resection arthroplasty (the joint surface's of the metacarpal and the trapezium are resected) (18 thumbs), trapeziectomy with tendon interposition (17 thumbs) or trapezio-metacarpal arthrodesis (28 thumbs). Baseline characteristics were comparable in the three groups for mean age at operation, Eaton classification, left right distribution and dominant hands operated. The average follow-up was 13 years for the resection group, 8 years for the trapeziectomy group and 9 years for the arthrodesis group. No statistically significant difference between the three groups was found for the visual analogue pain and satisfaction scale, pain frequency nor DASH score. Patients in the trapeziectomy group had significantly less pain compared to the arthrodesis group (p=0.025). Statistically, radial abduction was significantly better after trapeziectomy compared to resection arthroplasty (p<0.01) or arthrodesis (p=0.01). There was no difference among the three groups in grip and tip pinch strength nor in pain on palpation. None of the patients in the trapeziectomy group needed a re-operation, one patient in the resection arthroplasty group had a re-operation, and 22 patients in the arthrodesis group had one or more re-operations for hardware removal or because of a complication. This study shows that the resection arthroplasty has equally good long term results compared to trapeziectomy combined with tendon interposition or arthrodesis. Resection arthroplasty is performed through a single incision and is technically simple. In our clinic resection arthroplasty is therefore the preferred technique for the treatment of osteoarthritis of the trapeziometacarpal joint.

L’arthrose trapézométacarpienne est fréquente, souvent bilatérale et atteint de façon prédominante les femmes post ménopausées. En cas d’échec du traitement conservateur, la chirurgie est une excellente option de traitement. Le but de cette étude est de comparer trois techniques chirurgicales.

Patients et méthode: 63 patients (74 pouces) présentant une arthrose trapézométacarpienne ont été traités chirurgicalement, 54 patients ont été suivis régulièrement, 7 sont décédés et 2 perdus de vue. Les patients ont été classés en fonction du traitement, résection arthroplastique (18 pouces) trapézectomie avec inter position tendineuse (17 pouces) et arthrodèse 28 pouces. Les données de ces patients étaient comparables dans les trois groupes en ce qui concerne l’âge, l’intervention, la classification d’Eaton, la latéralisation des lésions et la main dominante. Le suivi moyen a été de 13 ans pour le groupe résection, 8 ans pour le groupe trapézectomie et de 9 ans pour le groupe arthrodèse.

Résultats: il n’y a pas de différence significative entre ces trois groupes sur le plan de la douleur et de la satisfaction ainsi que du score DASH. Les patients du groupe trapézectomie, ont significativement moins de douleur si on les compare au groupe arthrodèse (p=0.025). L’abduction est de façon significative plus importante après trapézectomie si on la compare au groupe résection (p<0.01) ou arthrodèse (p=0.01). Il n’y a pas de différence significative dans les trois groupes en termes de force, de serrage, de pince, ni en termes de douleur à la palpation. Aucun de ces patients après trapézectomie n’a nécessité de réintervention alors qu’un patient du groupe résection arthroplastique a dû être réopéré et 22 patients du groupe arthrodèse ont eu une ou plusieurs réinterventions, soit pour ablation de matériel soit du fait d’une complication.

En conclusion, cette étude montre que la résection arthroplastique donne un résultat à long terme équivalent aux autres techniques. La résection arthropastique peut être réalisée par une petite incision, elle est extrêmement simple sur le plan chirurgical. Dans notre établissement, la résection arthroplastique est devenue la technique de choix pour le traitement des arthroses trapézométacarpienne. Niveau d’évidence III–Etude de cohorte rétrospective.

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Figures

Fig. 1
Fig. 1
a, b Patient A, preoperative X-rays of a 61 year old female. Eaton stage 2 joint destruction. c, d Patient A one year postoperative, no complaints. e, f Patient A, 10 years postoperative. DASH, VAS for pain and satisfaction all 0 points (maximum score)
Fig. 2
Fig. 2
a, b Patient B, preoperative X-rays of a 61 year old female. Eaton stage 2 joint destruction. c, d Patient B, direct postoperative X-rays showing the trapezio-metacarpal arthrodesis with the plate washer technique. e, f Patient B, X-rays after five years of follow-up showing a completely united arthrodesis. DASH 54, VAS for pain 30 and for satisfaction 25
Fig. 3
Fig. 3
a, b Patient C, preoperative X-rays of a 62 year old female. Eaton stage 2 joint destruction. c, d Patient C, X-rays after five years follow-up of trapeziectomy with tendon interposition showing a slight calcification on the lateral X ray. DASH 10 points, VAS for pain and for satisfaction both 0 points
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