Article
Pyrocarbon disc interposition for CMC thumb joint osteoarthritis – Difference in use of the FCR or APL tendon?
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Authors
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Cecile Van Laarhoven
- Erasmus Medical Center, Rotterdam, Netherlands
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Mark Van Heijl
- Diakonessenhuis, Utrecht, Netherlands
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Arnold Schuurman
- University Medical Center Utrecht, Utrecht, Netherlands
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Brigitte Van Der Heijden
- Jeroen Bosch Hospital, s Hertogenbosch, Netherlands
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: For treatment of CMC thumb joint osteoarthritis, a pyrocarbondisc can be used after distal hemitrapeziectomy as interposition arthroplasty. This disc can be secured with either a strip of the Flexor Carpi Radialis (FCR) or Abductor Pollicis Longus (APL) tendon. We analyzed outcomes after both techniques in a large cohort.
Methods: Out of 188 pyrocarbon disc interposition arthroplasties, we analyzed 30 discs secured with the FCR tendon and 76 discs secured with the APL tendon, operated between 2006 and 2011 by 2 independent surgeons. As primary outcome we used Patient Reported Outcome Measurements (PROMs); DASH, PRWHE, MHQ and satisfaction. As secondary outcome we analyzed hand measurements, such as power of grip (JAMAR dynamometer), power of pinch (pinchmeter) and range of motion (Kapandji and pollexograph).
Results and Conclusions: Baseline characteristics of both groups were quite similar. Difference in men and women in the groups was not significant (p=0.150). Mean follow up was 8.1 years for the APL group and 9.1 years for the FCR group. In the APL group 67 discs were in situ at time of follow up, in the FCR group 29 discs. In both groups 35% of the patients had bilateral complaints. Results are shown in Table 1 [Tab. 1].
For the primary outcomes, the PROMs questionnaires, there were no significant differences. For the secondary outcome, the different hand measurements, the FCR-group showed significant better JAMAR, tippinch and abduction, the APL group showed significant better keypinch.
Pyrocarbon disc interposition arthroplasty can be performed with an APL or FCR tendon, both with acceptable results. At long term follow up there were no significant differences in the different measured PROMs. For the hand measurements, grip power, tippinch and abduction in range of motion were significant better in the FCR group, and keypinch was significant better in the APL group. When a patient specifically wishes more range of motion and grip power, the use of the FCR tendon can be recommended for pyrocarbon disc interposition arthroplasty.
