Article
Treatment of osteoarthritis of the carpometacarpal joint of the thumb with trapeziectomy and tendon allograft interposition
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Authors
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Nadine Hollevoet
- Ghent University Hospital, Ghent, Belgium
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Camille Thys
- Ghent University Hospital, Ghent, Belgium
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Lieselot Vekens
- Ghent University Hospital, Ghent, Belgium
| Published: | February 6, 2020 |
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Outline
Text
Objectives/Interrogation: One of the surgical treatment options for osteoarthritis of the carpometacarpal (CMC) joint of the thumb is tendon interposition after partial or total trapeziectomy, with or without ligament reconstruction. Usually a tendon autograft is used. The advantage of a tendon allograft is shorter operation time. The aim of the study was to evaluate patients who were treated with tendon allografts.
Methods: Forty-eight patients (56 hands) were operated on between 2006 and 2015 with tendon allografts for osteoarthritis of the CMC joint of the thumb. Thirty-four patients (41 hands) were included in the study. Ten patients were male and 20 female. Mean age was 59 years. In 11 hands partial trapeziectomy with tendon interposition was done, in 20 partial trapeziectomy with tendon interposition and ligament reconstruction, in 1 total trapeziectomy with tendon interposition and in 9 total trapeziectomy with tendon interposition and ligament reconstruction.
Patients were evaluated with the disabilities of hand and shoulder (DASH) and visual analogue scale (VAS) for pain. Patients were also asked if they were satisfied. In 23 patients (29 hands) clinical evaluation was done (Kapandji score, thumb abduction, key pinch). Eleven patients (12 hands) could not come to the hospital and the questionnaires were sent to their homes. Mean follow-up was 57 months (range: 15-124).
Results and Conclusions: Mean DASH score was 19 and mean VAS for pain 1.3. Eighty-three percent of patients were satisfied.
Mean Kapandji score was 9.3, mean abduction measured 56° and mean key pinch 5.1 kg.
Four patients needed a surgical revision procedure (9.8%). In one the tendon graft was removed because of infection, in another a partial trapeziectomy was converted into a total trapeziectomy, one had an additional interposition of the scaphotrapezoidal joint and in another patient with spasticity an arthrodesis was performed because of adduction contracture of the thumb.
In conclusion, trapeziectomy with donor tendon interposition is one of the treatment options for CMC joint osteoarthritis of the thumb. Good results can be obtained in about 80% of patients which is similar to other treatment options such as total joint arthroplasty.
