Surgical treatment of primary trapezio-metacarpal osteoarthritis by trapeziectomy and ligament reconstruction without tendon interposition. Long-term results of 50 cases

BACKGROUND: Primary trapezio-metacarpal osteoarthritis can be painful and disabling. Surgical treatment is used when conservative treatment, such as splinting or oral analgesics, fails. The purpose of this study was to report the long-term outcomes obtained in 40 patients (50 thumbs) surgically treated for thumb osteoarthritis by trapeziectomy and ligament reconstruction without tendon interposition. MATERIALS AND METHODS: Forty patients (50 thumbs), with severe trapezio-metacarpal osteoarthritis, surgically treated by trapeziectomy and ligament reconstruction without tendon interposition were reviewed after an average follow-up of 8 years. All patients were women. At follow-up, clinical results were evaluated on the basis of the DASH score, possible presence of pain and the following criteria: palmar abduction of the thumb, carpometacarpal joint opposition of the thumb (Kapandji), extension of the metacarpophalangeal joint and strength of the hand. RESULTS: The DASH score improved from 42.65 (preoperatively) to 16 (at follow-up), and most patients were asymptomatic. Palmar abduction of the thumb averaged 57 mm. Carpometacarpal joint opposition averaged 8.8. Metacarpophalangeal extension was abnormally increased in 86% of the cases. The strength of the operated hand was comparable to the contralateral side in 46 cases. Radiographic examinations showed a slight proximal migration of the first metacarpal bone (< 3 mm) in all cases but mild signs of carpometacarpal osteoarthritis in only 4 cases. CONCLUSIONS: Based on the reported experience, we believe that primary trapezio-metacarpal osteoarthritis surgically treated by trapeziectomy and ligament reconstruction without tendon interposition allows good long-term results. LEVEL OF EVIDENCE: Therapeutic IV