Artikel
Arthroscopic distal hemitrapeziectomy versus open distal hemitrapeziectomy without interposition in osteoarthritis of the first CMC joint – Two year follow up results of a randomized controlled trial
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Autoren
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Cecile Van Laarhoven
- Erasmus Medical Center, Rotterdam, Netherlands
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Martijn Baas
- Erasmus Medical Center, Rotterdam, Netherlands
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Henk Coert
- University Medical Center Utrecht, Utrecht, Netherlands
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Michiel Zuidam
- Erasmus Medical Center, Rotterdam, Netherlands
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Richard Koch
- Haga Hospital, Den Haag, Netherlands
| Veröffentlicht: | 6. Februar 2020 |
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Gliederung
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Objectives/Interrogation: For osteoarthritis of the CMC thumb joint, trapeziectomy is described as the treatment with least complications. Removal of the total trapezium, gives a higher chance to shortening and collapse of the thumb, with less postoperative strength. Distal hemitrapeziectomy doesn't have these drawbacks. The last years there is more experience in arthroscopic surgeries for the CMC thumb joint.
The objective of this study is to compare arthroscopic with open hemitrapeziectomy without tendon interposition in a randomized controlled trial.
Methods: All patients with Eaton and Littler grade 2 or 3, seen on the outpatient clinic, with failed conservative therapy, were asked to participate in the study. After obtaining informed consent, patients were randomized to either open or arthroscopic distal hemitrapeziectomy. Patients filled in the Patient Reported Wrist and Hand Evaluation (PRWHE) and hand measurements were done preoperative and at 3, 6, 12 and 24 months postoperative.
Results and Conclusions: We included 87 patients; 42 in the open group and 45 in the arthroscopic group. The mean operation time for the open technique was 25min and 35min for the arthroscopic technique (significant p=0.00).
The preliminary results are shown in Table 1 [Tab. 1]. The PRWHE showed significant improvement at 26 weeks, 1 year and at 2 years for both groups, compared to preoperative (no significance between groups). Satisfaction was good to excellent for the open group in nearly 80% and nearly 70% for the arthroscopic group. The grip power also improved significantly at 1 and 2 year follow up for both groups, compared to preoperatively. The range of motion with Kapandji was 9 preoperative and improved to 10 for both groups at follow up.
These are the preliminary results of our RCT arthroscopic versus open distal hemitrapeziectomy. The results show a significant improvement for both techniques after 1 and 2 year follow up, but not between groups, except for operation time. At the time of the congress, we will present the results of 87 patients with a minimum of 1-year follow up and 50 patients with a minimum of 2 year follow up.
