Long-Term Outcomes of Trapeziometacarpal Arthrodesis in the Management of Trapeziometacarpal Arthritis

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Abstract

Purpose: Reported outcomes of trapeziometacarpal (TM) arthrodesis have been contradictory. The purpose of this paper is to review the long-term results of TM arthrodesis for arthritis with respect to clinical outcomes, union, development of adjacent joint arthritis, and complications. Methods: A retrospective review of TM arthrodeses performed between 1970 and 2003 was undertaken. Among a total of 241 arthrodeses performed, 126 thumbs in 114 patients (79 women, 35 men) treated for osteoarthritis were available for follow-up evaluation. Pre- and postoperative clinical and radiographic data were reviewed. The average age was 57 years (range 32-77). The dominant hand was involved in 76 cases. Supplemental bone graft was used in 90 thumbs. Preoperative appositional (key) pinch, oppositional (tip) pinch, and grip strengths were 3.0 kg, 2.7 kg, and 14 kg, respectively. The average pain score on a scale of 0-10 was 6.6 (range 4-10). The average follow-up was 11.2 years (range 3-28 years). Results: There were 17 nonunions. No correlation existed between the incidence of nonunion and the use of supplemental bone graft. Nine of 17 thumbs had re-operation, including revision arthrodesis (6) and interposition or suspensionplasty (3). The appositional pinch, oppositional pinch, and grip strengths improved to 5.9 kg, 5.4 kg, and 23 kg, respectively (p < .01). The average pain score improved to 0.4 (p < .01). Radiographic progression of scaphotrapeziotrapezoid arthritis occurred in 39 cases; however, only 8 of these were symptomatic. Development of metacarpophalangeal arthritis was noted in 16 thumbs; none have been clinically relevant. Conclusions: For most patients TM arthrodesis reduces pain, improves function and results in excellent patient satisfaction. Despite the development of metacarpophalangeal and scaphotrapeziotrapezoid joint arthritis, intervention for these joints was rarely warranted. Type of study/level of evidence: Therapeutic IV.

Original languageEnglish (US)
Pages (from-to)20-26
Number of pages7
JournalJournal of Hand Surgery
Volume34
Issue number1
DOIs
StatePublished - Jan 2009

Fingerprint

Arthrodesis
Arthritis
Thumb
Pinch Strength
Hand Strength
Pain
Joints
Transplants
Metacarpophalangeal Joint
Bone and Bones
Patient Satisfaction
Osteoarthritis
Hand
Incidence

Keywords

  • arthrodesis
  • Thumb arthritis
  • trapeziometacarpal joint

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery

Cite this

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title = "Long-Term Outcomes of Trapeziometacarpal Arthrodesis in the Management of Trapeziometacarpal Arthritis",
abstract = "Purpose: Reported outcomes of trapeziometacarpal (TM) arthrodesis have been contradictory. The purpose of this paper is to review the long-term results of TM arthrodesis for arthritis with respect to clinical outcomes, union, development of adjacent joint arthritis, and complications. Methods: A retrospective review of TM arthrodeses performed between 1970 and 2003 was undertaken. Among a total of 241 arthrodeses performed, 126 thumbs in 114 patients (79 women, 35 men) treated for osteoarthritis were available for follow-up evaluation. Pre- and postoperative clinical and radiographic data were reviewed. The average age was 57 years (range 32-77). The dominant hand was involved in 76 cases. Supplemental bone graft was used in 90 thumbs. Preoperative appositional (key) pinch, oppositional (tip) pinch, and grip strengths were 3.0 kg, 2.7 kg, and 14 kg, respectively. The average pain score on a scale of 0-10 was 6.6 (range 4-10). The average follow-up was 11.2 years (range 3-28 years). Results: There were 17 nonunions. No correlation existed between the incidence of nonunion and the use of supplemental bone graft. Nine of 17 thumbs had re-operation, including revision arthrodesis (6) and interposition or suspensionplasty (3). The appositional pinch, oppositional pinch, and grip strengths improved to 5.9 kg, 5.4 kg, and 23 kg, respectively (p < .01). The average pain score improved to 0.4 (p < .01). Radiographic progression of scaphotrapeziotrapezoid arthritis occurred in 39 cases; however, only 8 of these were symptomatic. Development of metacarpophalangeal arthritis was noted in 16 thumbs; none have been clinically relevant. Conclusions: For most patients TM arthrodesis reduces pain, improves function and results in excellent patient satisfaction. Despite the development of metacarpophalangeal and scaphotrapeziotrapezoid joint arthritis, intervention for these joints was rarely warranted. Type of study/level of evidence: Therapeutic IV.",
keywords = "arthrodesis, Thumb arthritis, trapeziometacarpal joint",
author = "Marco Rizzo and Moran, {Steven Lawrence} and Shin, {Alexander Yong-Shik}",
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T1 - Long-Term Outcomes of Trapeziometacarpal Arthrodesis in the Management of Trapeziometacarpal Arthritis

AU - Rizzo, Marco

AU - Moran, Steven Lawrence

AU - Shin, Alexander Yong-Shik

PY - 2009/1

Y1 - 2009/1

N2 - Purpose: Reported outcomes of trapeziometacarpal (TM) arthrodesis have been contradictory. The purpose of this paper is to review the long-term results of TM arthrodesis for arthritis with respect to clinical outcomes, union, development of adjacent joint arthritis, and complications. Methods: A retrospective review of TM arthrodeses performed between 1970 and 2003 was undertaken. Among a total of 241 arthrodeses performed, 126 thumbs in 114 patients (79 women, 35 men) treated for osteoarthritis were available for follow-up evaluation. Pre- and postoperative clinical and radiographic data were reviewed. The average age was 57 years (range 32-77). The dominant hand was involved in 76 cases. Supplemental bone graft was used in 90 thumbs. Preoperative appositional (key) pinch, oppositional (tip) pinch, and grip strengths were 3.0 kg, 2.7 kg, and 14 kg, respectively. The average pain score on a scale of 0-10 was 6.6 (range 4-10). The average follow-up was 11.2 years (range 3-28 years). Results: There were 17 nonunions. No correlation existed between the incidence of nonunion and the use of supplemental bone graft. Nine of 17 thumbs had re-operation, including revision arthrodesis (6) and interposition or suspensionplasty (3). The appositional pinch, oppositional pinch, and grip strengths improved to 5.9 kg, 5.4 kg, and 23 kg, respectively (p < .01). The average pain score improved to 0.4 (p < .01). Radiographic progression of scaphotrapeziotrapezoid arthritis occurred in 39 cases; however, only 8 of these were symptomatic. Development of metacarpophalangeal arthritis was noted in 16 thumbs; none have been clinically relevant. Conclusions: For most patients TM arthrodesis reduces pain, improves function and results in excellent patient satisfaction. Despite the development of metacarpophalangeal and scaphotrapeziotrapezoid joint arthritis, intervention for these joints was rarely warranted. Type of study/level of evidence: Therapeutic IV.

AB - Purpose: Reported outcomes of trapeziometacarpal (TM) arthrodesis have been contradictory. The purpose of this paper is to review the long-term results of TM arthrodesis for arthritis with respect to clinical outcomes, union, development of adjacent joint arthritis, and complications. Methods: A retrospective review of TM arthrodeses performed between 1970 and 2003 was undertaken. Among a total of 241 arthrodeses performed, 126 thumbs in 114 patients (79 women, 35 men) treated for osteoarthritis were available for follow-up evaluation. Pre- and postoperative clinical and radiographic data were reviewed. The average age was 57 years (range 32-77). The dominant hand was involved in 76 cases. Supplemental bone graft was used in 90 thumbs. Preoperative appositional (key) pinch, oppositional (tip) pinch, and grip strengths were 3.0 kg, 2.7 kg, and 14 kg, respectively. The average pain score on a scale of 0-10 was 6.6 (range 4-10). The average follow-up was 11.2 years (range 3-28 years). Results: There were 17 nonunions. No correlation existed between the incidence of nonunion and the use of supplemental bone graft. Nine of 17 thumbs had re-operation, including revision arthrodesis (6) and interposition or suspensionplasty (3). The appositional pinch, oppositional pinch, and grip strengths improved to 5.9 kg, 5.4 kg, and 23 kg, respectively (p < .01). The average pain score improved to 0.4 (p < .01). Radiographic progression of scaphotrapeziotrapezoid arthritis occurred in 39 cases; however, only 8 of these were symptomatic. Development of metacarpophalangeal arthritis was noted in 16 thumbs; none have been clinically relevant. Conclusions: For most patients TM arthrodesis reduces pain, improves function and results in excellent patient satisfaction. Despite the development of metacarpophalangeal and scaphotrapeziotrapezoid joint arthritis, intervention for these joints was rarely warranted. Type of study/level of evidence: Therapeutic IV.

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