Artikel
Stage III basal joint arthritis of the thumb: Clinical and radiological outcome after total trapeziectomy and ligament reconstruction and tendon interposition (LRTI) with partial Flexor carpi radialis (FCR) tendon
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Autoren
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Sang-Eun Park
- Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, South Korea
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Eung-Sic Kim
- Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, South Korea
| Veröffentlicht: | 6. Februar 2020 |
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Gliederung
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Objectives/Interrogation: Thumb basal joint arthritis is common. Total trapeziecomy and ligament reconstruction and tendon interposition (LRTI) is commonly used surgical option for the stage III, IV basal joint arthritis of the thumb. We reported the clinical and radiological outcome after total trapeziecomy and LRTI with partial FCR tendon for the stage III basal joint arthritis of the thumb.
Methods: A retrospective review was performed for the patients treated with total trapeziecomy and LRTI for their stage III basal joint arthritis of the thumb. Functional outcome was evaluated with a DASH questionnaire and visual analog scale (VAS) pain score. Clinical evaluation examined grip strength and lateral key pinch in kilograms-force. For the radiologic evaluation. stressed and unstressed radiographs assessed metacarpal proximal migration. To evaluate proximal migration, an anteroposterior (AP) wrist view (with true thumb lateral position) was used. The degree of proximal migration was compared with contralateral wrist X-ray and expressed with percentile ratio both at rest and maximal-effort tip pinch.
Results and Conclusions: This study included 18 patients (male 1, female 17) who underwent total trapeziectomy and LRTI for their stage III basal joint arthritis of the thumb. The average age was 62 years (range 57-77 years). The mean follow-up period was 18 months (range, 12 to 27 months). 10 of the affected hands were non-dominant hand.
VAS improved from a preoperative mean of 5.7(at daily living activities) and 7.9(at sports or occupational activities) to a postoperative mean of 1.3 and 2.3, respectively (P < .01). DASH also improved significantly from a preoperative mean of 73(range, 54 to 92) to a postoperative mean of 23 (range, 16 to 43) (P< .05). Grip strength and lateral key pinch improved from a preoperative mean of 13.2kg (range, 5 to 18) to 22.4kg (range 16 to 26) and 3.4kg (range, 1.3 to 4.5) to 5.4kg (range, 4.5 to 7.2) (P< .05). The mean proximal migration was 27% (range, 11 to 43) at rest and 53% (range, 43 to 68) at maximal tip pinch. Conclusively, this study suggest that total trapeziectomy and LRTI with partial FCR tendon is an effective surgical treatment for the stage III basal joint arthritis of the thumb and provides stable, painless thumb.
