Outcome of trapeziectomy with ligament reconstruction tendon interposition for the treatment of advanced thumb carpometacarpal arthritis: a prospective study

Authors

  • Eknoor Kaur Department of Orthopedics, SMS medical college and attached Hospitals, Jaipur, Rajasthan, India
  • Narender Saini Department of Orthopedics, SMS medical college and attached Hospitals, Jaipur, Rajasthan, India
  • Shashank Sharma Department of Orthopedics, SMS medical college and attached Hospitals, Jaipur, Rajasthan, India
  • Devi Sahai Meena Department of Orthopedics, SMS medical college and attached Hospitals, Jaipur, Rajasthan, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20210616

Keywords:

Thumb carpometacarpal arthritis, Trapeziectomy, CMC arthritis, Flexor carpi radialis, LRTI

Abstract

Background: The purpose of this study is to assess the functional outcome of the cases with advanced thumb carpometacarpal (CMC) arthritis treated with trapeziectomy and ligament reconstruction tendon interposition (LRTI) in terms of visual analogue scale (VAS), disabilities of the arm, shoulder and hand (DASH) score, Kapandji score, range of motion (ROM) of radial and volar abduction of the thumb, grip power, key pinch and the height of the trapezial space.

Methods: In a prospective before and after interventional study of 30 patients with the advanced thumb CMC joint arthritis underwent the procedure. An average follows up period was 17.9 months.

Results: The mean VAS decreased from 8.17 to 2.70. The mean Kapandji score and DASH score improved from 3.47 and 71.62 preoperative to 8.23 and 14.46 postoperative.  Mean ROM for radial and volar abduction increased from 42.57° and 48° to 61°and 64.73° respectively. Mean key pinch power and grip power increased from 2.80 kg and 3.47 kg to 4.70 kg and 9.01 kg respectively.  There was a significant decrease in height of the trapezial space. Three patient complaint of the persistent pain at the surgical site and not much improvement in the DASH score.

Conclusions:  Trapeziectomy with LRTI using flexor carpi radialis (FCR) transfer is an effective treatment for the advanced thumb CMC arthritis. This procedure stabilizes thumb metacarpal and provide enough support which prevents the collapse of metacarpal into dead space.

Author Biography

Eknoor Kaur, Department of Orthopedics, SMS medical college and attached Hospitals, Jaipur, Rajasthan, India

department of orthopaedics , senior resident

References

Wolf J, Turkiewicz A, Atroshi I, Englund M. Prevalence of doctor-diagnosed thumb carpometacarpal joint osteoarthritis: An analysis of Swedish health care. Arthritis Care research. 2014;66:961-7.

Cooney WP III, Chao EY. Biomechanical analysis of static forces in the thumb during hand function. J Bone Joint Surg Am. 1977;59:27-36.

Barron OA, Glickel SZ, Eaton RG. Basal joint arthritis of the thumb. JAAOS. 2000;8(5):314-23.

Berger B, Linscheid RL. Arthroplasty in the Hand and Wrist. In: Green DP, Hotchkiss RN, Pederson WC, Wolfe SW editors. Green’s operative hand surgery. 5th ed. Amsterdam: Elsevier. 2007.

Sodha S, Ring D, Zurakowski D, Jupiter JB. Prevalence of osteoarthritis of the trapeziometacarpal joint. J Bone Joint Surg Am. 2005;87(12):2614-8.

Armstrong AL, Hunter JB, Davis TR. The prevalence of degenerative arthritis of the base the thumb in post- menopausal women. J Hand Surg. 1994;19(3):340-1.

Burton RI, Pellegrini VD. Surgical management of basal joint arthritis of the thumb. Part II: Ligament reconstruction with tendon interposition arthroplasty. J Hand Surg Am. 1986;11(3):324-32.

Eaton RG, Glickel SZ, Littler JW. Tendon interposition arthroplasty for degenerative arthritis of the trapeziometacarpal joint of the thumb. J Hand Surg. 1985;10:645-54.

Wang T, Zhao G, Yong-Jun R, Mi J. Outcomes of modified trapeziectomy with ligament reconstruction tendon interposition for the treatment of advanced thumb carpometacarpal arthritis Two-years follow up. Wolters Kluwer Health. Inc Medicine 2018;97:13(e0235).

De Smet L, Vanfleteren L, Sioen W, Spaepen D, Ransbeeck HV et al. Ligament reconstruction/tendon interposition arthroplasty for thumb basal joint osteoarthritis preliminary results of a prospective outcome study. Acta Orthop Belg. 2002;68:20-3.

Li J, Li D, Tian G, Zhang W. Comparison of arthrodesis and arthroplasty of Chinese thumb carpometacarpal osteoarthritis. J Orthop Surg Res. 2014;14:404.

Bhat M, Davis T, Bannerjee A. Trapezial space height measurement after trapeziectomy: A comparison of the use of standard and stress radiographs. J Hand Surg. 2003;28A:390-96.

Vinycomb T, Crock J. Trapeziectomy with ligament reconstruction and tendon interposition: a minimum 10-year follow-up. Hand Surg. 2013;18:365-8.

Tomaino MM, Coleman K. Use of the entire width of the flexor carpi radialis tendon for the ligament reconstruction tendon interposition arthroplasty does not impair wrist function. Am J Orthop. 2000;29:283-4.

Trumble T, Rafijah G, Heaton D. Thumb carpometacarpal arthroplasty with ligament reconstruction and interposition costochondral arthroplasty. J Wrist Surg. 2013;2(3):220-7.

Downloads

Published

2021-02-23

Issue

Section

Original Research Articles