Modified total trapezial and partial trapezoidal excision and ligament reconstruction tendon interposition reduces symptoms in isolated scaphotrapezial-trapezoid arthritis of the wrist

2012 ◽  
Vol 37 (7) ◽  
pp. 637-641 ◽  
Author(s):  
J. Andrachuk ◽  
S. S. Yang
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
Ligament Reconstruction ◽  
Pinch Strength ◽  
Wrist Flexion ◽  
Pain Scores ◽  
Excision Arthroplasty ◽  
Tendon Interposition

Trapezial excision arthroplasty with ligament reconstruction and tendon interposition (LRTI) modified to include proximal trapezoid excision was performed on 12 wrists in 10 patients with symptomatic, isolated scaphotrapezial-trapezoid (STT) arthritis. Wrist range of motion, lateral pinch and grip strength, and analog pain scores were measured pre- and post-operatively. Mean follow-up was 18 (11–42) months. Post-operatively, reported pain scores uniformly decreased ( p < 0.0001). Mean range of wrist flexion increased from 48 to 53° ( p < 0.05) and extension from 51 to 55° ( p < 0.05). There was also an overall increase in mean grip strength from 15.6 to 19.2 kg and pinch strength from 3.5 to 4.3 kg. Modified Mayo Wrist Scores were excellent in six cases, good in three, and fair in one. Our results suggest that modified total trapezial, partial trapezoidal excision and LRTI could be an effective surgical alternative in cases of isolated STT arthritis.

Outcomes of cementless joint prosthesis versus tendon interposition for trapeziometacarpal osteoarthritis: a prospective study

2018 ◽  
Vol 44 (2) ◽  
pp. 151-158 ◽  
Author(s):  
Roman Cebrian-Gomez ◽  
Alejandro Lizaur-Utrilla ◽  
Emilio Sebastia-Forcada ◽  
Fernando A. Lopez-Prats
Keyword(s):  
Ligament Reconstruction ◽  
Pinch Strength ◽  
Level Of Evidence ◽  
Trapeziometacarpal Osteoarthritis ◽  
The Mean ◽  
A Prospective Study ◽  
Tendon Interposition ◽  
Mid Term Results ◽  
Dash Questionnaire

We compared 84 patients with the Ivory trapeziometacarpal prosthesis versus 62 with ligament reconstruction and tendon interposition arthroplasty performed for osteoarthritis. There were 134 women and 12 men with a mean age of 60 years. Prospective clinical assessment was made using the Quick Disability of the Arm, Shoulder and Hand (DASH) questionnaire, visual analogue scale for pain, range of motion, and grip and pinch strength. The mean follow-up was 4 years (range 2–5). Prosthetic replacement provided significantly better thumb abduction, adduction, pinch strength, QuickDASH, pain relief, satisfaction and a faster return to daily activities and previous work. Revision surgery was required for two patients in the prosthesis group, two for dislocation and one cup loosening, while in the ligament reconstruction group there were no revisions. We conclude that trapeziometacarpal prosthesis provides better mid-term results in terms of function compared with ligament reconstruction and tendon interposition for patients with Stages 2 and 3 osteoarthritis of the trapeziometacarpal joint. Level of evidence: II

scholarly journals Early Correction of Distal Radius Partial Articular Malunion Leads to Good Long-term Functional Recovery at Mean Follow-up of 4 Years

Hand ◽  
2018 ◽  
Vol 15 (2) ◽  
pp. 276-280 ◽  
Author(s):  
T. David Luo ◽  
Fiesky A. Nunez ◽  
Elizabeth A. Newman ◽  
Fiesky A. Nunez
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
Distal Radius ◽  
Articular Surface ◽  
Corrective Osteotomy ◽  
Young Patients ◽  
Posttraumatic Arthritis ◽  
Volar Approach ◽  
Pain Scores

Background: Distal radius articular step-off or deformity may cause posttraumatic arthritis and poor functional outcome. The purpose of this study was to evaluate pain and functional outcomes in patients with malunited partial articular distal radius fractures who underwent corrective osteotomy. We hypothesized that anatomic restoration of distal radius articular surface after a malunited partial articular distal radius fracture results in improvement in pain and functional measures and delays the development of posttraumatic arthritis. Methods: Seven consecutive patients with mean age of 38 years underwent corrective osteotomy via either a standard dorsal approach or combined dorsal and volar approach. Mean time from injury to corrective osteotomy was 10 weeks. Patients were assessed with respect to Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), forearm and wrist range of motion, pain, and grip strength. Results: At mean follow-up of 44 months, significant improvements in pain scores (7.1-0.9, P < .001), QuickDASH (38.7-11.6, P < .001), grip strength (21.4-30.0 kg, P = .01) were achieved. All range of motion measurements demonstrated significant improvements except forearm pronation. One patient demonstrated radiographic evidence of osteoarthritis but had no pain at final follow-up. No patients required secondary surgery for removal of symptomatic hardware. Conclusions: Based on these findings, we recommend that early corrective osteotomies should be considered in young patients with intra-articular distal radius malunions before considering salvage procedures such as partial or complete wrist arthrodesis.

scholarly journals Comparison of arthrodesis and arthroplasty of Chinese thumb carpometacarpal osteoarthritis

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Jianfeng Li ◽  
Dacun Li ◽  
Guanglei Tian ◽  
Wentong Zhang
Keyword(s):  
Grip Strength ◽  
Ligament Reconstruction ◽  
Subjective Evaluation ◽  
Chinese Patients ◽  
Pinch Strength ◽  
Dash Score ◽  
Advantages And Disadvantages ◽  
Thumb Carpometacarpal ◽  
Tendon Interposition ◽  
Carpometacarpal Osteoarthritis

Abstract Background The thumb carpometacarpal (CMC) osteoarthritis is very common. Multiple methods are used to treat progressive thumb CMC osteoarthritis, among which trapeziometacarpal arthrodesis and trapezial excision with ligament reconstruction and tendon interposition (LRTI) are the most common. These two surgical treatment methods have received mixed reviews in previous studies in the west patients. This retrospective study studied the effects, advantages, and disadvantages of arthrodesis and arthroplasty for treating thumb carpometacarpal osteoarthritis in Chinese patients. Methods Between February 2012 and September 2017, 39 Chinese patients with stage II or III thumb carpometacarpal osteoarthritis underwent surgery (trapeziometacarpal arthrodesis in 22, trapezial excision with ligament reconstruction and tendon interposition in 17). Postoperative objective and subjective evaluations were performed. The objective evaluation involved grip strength, pinch strength, thumb abduction degree (palmar and radial), and Kapandji opposition scores. The subjective evaluation involved visual analog scale (VAS) and Disabilities of the Arm, Shoulder, and Hand (DASH) scores. Results Intergroup differences in pinch strength, thumb abduction degrees (palmar and radial), and Kapandji opposition scores were obvious, whereas those in grip strength, VAS score, and DASH score were not. Conclusion In Chinese patients, both techniques relieved pain and improve grip strength. Arthrodesis displayed better pinch strength, while arthroplasty displayed better motor function. Patients were satisfied with the effects of both techniques.

Changes in Key Pinch Strength after Excision of the Trapezium and Total Joint Arthroplasty

2004 ◽  
Vol 29 (1) ◽  
pp. 40-41 ◽  
Author(s):  
L. DE SMET ◽  
W. SIOEN ◽  
D. SPAEPEN
Keyword(s):  
Total Joint Arthroplasty ◽  
Ligament Reconstruction ◽  
Joint Arthroplasty ◽  
Pinch Strength ◽  
Pinch Force ◽  
Basal Joint ◽  
Tendon Interposition ◽  
Joint Arthritis

Key pinch force was measured preoperatively and at follow-up (mean 25 months) in patients treated for basal joint arthritis by either trapziectomy with ligament reconstruction and tendon interposition ( n=26) or total joint arthroplasty ( n=27). There was a significant increase in key pinch strength with both treatments, but no difference between the two treatments. Total joint arthroplasty does not appear to produce stronger key pinch than trapziectomy with ligament reconstruction and tendon interposition.

Trapeziectomy and ligament reconstruction tendon interposition for isolated scaphotrapeziotrapezoid osteoarthritis of the wrist

2013 ◽  
Vol 39 (8) ◽  
pp. 833-837 ◽  
Author(s):  
R. Langenhan ◽  
B. Hohendorff ◽  
A. Probst
Keyword(s):  
Analogue Scale ◽  
Ligament Reconstruction ◽  
Pinch Strength ◽  
Dash Score ◽  
Trapeziometacarpal Osteoarthritis ◽  
Osteoarthritis Of The Wrist ◽  
Pain At Rest ◽  
Tendon Interposition ◽  
Median Pain

Isolated osteoarthritis of the scaphotrapeziotrapezoid joint is rather rare compared with thumb trapeziometacarpal osteoarthritis. The aim of this retrospective study was to evaluate the outcome of 15 consecutive patients treated with trapeziectomy/ligament reconstruction tendon interposition for isolated scaphotrapeziotrapezoid osteoarthritis of the wrist. After a mean follow-up of 54 months, 14 patients (15 wrists) were available for clinical and radiological examination. The median pain intensity was 0 on a 0–10 visual analogue scale, both at rest and with activity, mean grip strength averaged 24 kg, pinch strength 5 kg. The disabilities of the arm, shoulder and hand (DASH) score was 16, and a modified Mayo Wrist Score 84. Correlation between the degree of scaphotrapezoid osteoarthritis and pain at rest, pain with activity, and DASH score was not significant. The findings from our study suggest that trapeziectomy/ligament reconstruction tendon interposition is an effective procedure for treating isolated scaphotrapeziotrapezoid osteoarthritis, and that additional partial trapezoid excision is not necessary.

scholarly journals Tendon versus Pyrocarbon Interpositional Arthroplasty in the Treatment of Trapeziometacarpal Osteoarthritis

2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
Won-Taek Oh ◽  
Yong-Min Chun ◽  
Il-Hyun Koh ◽  
Jong-Kwan Shin ◽  
Yun-Rak Choi ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Pyrolytic Carbon ◽  
Pinch Strength ◽  
Complication Rates ◽  
Pain Scores ◽  
Interpositional Arthroplasty ◽  
Trapeziometacarpal Osteoarthritis ◽  
Objective Outcomes ◽  
Tendon Interposition

Background. Trapeziometacarpal (TMC) arthritis is treated with surgery when nonsurgical treatment fails. The best surgical option for improving pain relief, functional outcomes, and postoperative complications remains controversial. The purpose of this study was to compare clinical and radiological outcomes and complications between trapezium excision with ligament reconstruction and tendon interposition (LRTI) and pyrolytic carbon interpositional arthroplasty. Methods. From March 2009 to August 2014, 37 patients (39 wrists) with Eaton-Littler stage II or III TMC arthritis underwent complete trapezium excision with LRTI (Group L, n=19) or pyrolytic interpositional arthroplasty (Group P, n=20). Visual analog scale (VAS) pain scores; grip and pinch strength; Kapandji scores to quantify thumb opposition; and Disabilities of Arm, Shoulder, and Hand (DASH) scores were used to compare clinical outcomes between the two groups. Radiographic changes (metacarpal shortening, subluxation, and radiolucency) were evaluated on the radiographs of thumb basal joints. Results. There were no differences in patient demographics, Eaton-Littler stage, preoperative outcome measures, or the duration of follow-up between the two groups. At the last follow-up, VAS pain scores, pinch and grip strengths, Kapandji scores, and DASH scores were significantly improved in both groups compared with preoperative scores. All follow-up measurements were similar between the two groups except pinch strength, which was 1.8 kg higher in Group P (p<0.001). Proximal metacarpal migration did not differ significantly between the groups. Periprosthetic lucency more than 1 mm was observed in 7 of 20 (35%) thumbs. Complication rates were similar between the two groups. Conclusions. All subjective and objective outcomes were similar following LRTI and pyrolytic interpositional arthroplasty in patients with TMC arthritis, except pinch strength, which was more improved following pyrolytic interpositional arthroplasty. Longer follow-up is required to test adverse effects of high rates of periprosthetic lucency and prosthetic subluxation on clinical outcomes after PyroDisk interpositional arthroplasty.

Lunotriquetral Ligament Reconstruction Utilizing a Palmaris Longus Autograft

2017 ◽  
Vol 22 (04) ◽  
pp. 544-547 ◽  
Author(s):  
Carl M. Harper ◽  
Matthew L. Iorio
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
Ligament Reconstruction ◽  
Longus Tendon ◽  
Palmaris Longus ◽  
Lunotriquetral Ligament ◽  
Palmaris Longus Tendon ◽  
Tendon Autograft

Injury to the lunotriquetral ligament can result in midcarpal instability, with resultant alterations in normal wrist kinematics and subsequent arthrosis. We performed a previously undescribed technique of lunotriquetral ligament reconstruction in two patients utilizing a palmaris longus tendon autograft. Average age at presentation was 24 years old with a mean follow up of 10 months. Average range of motion was 62.5° of flexion and 57.5° of extension. Total arc of motion was 83% of the contralateral uninvolved extremity. Average grip strength was 31 kg which was 91% of the contralateral extremity. Average Quick Disability of Arm, Shoulder and Hand score was 12.5 and Modern Activity Subjective Survey of 2007 was 1.5. No complications were noted.

scholarly journals Arthroscopic Abrasion Arthroplasty Is Not Superior to Ligament Reconstruction and Tendon Interposition for Thumb Carpometacarpal Arthritis

Hand ◽  
2018 ◽  
Vol 14 (6) ◽  
pp. 791-796
Author(s):  
Dominik Rog ◽  
Tuna Ozyurekoglu ◽  
Kumar K. Karuppiah
Keyword(s):  
Ligament Reconstruction ◽  
Analog Scale ◽  
Vas Score ◽  
Pain Scores ◽  
The Poor ◽  
The Mean ◽  
Thumb Carpometacarpal ◽  
Tendon Interposition ◽  
Cmc Joint

Background: A few arthroscopic options have been proposed for the treatment of early stages of the arthritis of the thumb carpometacarpal (CMC) joint. The purpose of this study was to compare the results of arthroscopic abrasion arthroplasty with ligament reconstruction and tendon interposition (LRTI). Methods: In this retrospective cohort study, 11 patients who underwent thumb CMC joint arthroscopic abrasion arthroplasty were compared with 15 patients who were randomly selected from a group of 80 LRTI arthroplasty patients during the same study period, with a minimum 1 year follow-up. Preoperative and postoperative evaluations included radiographs and measurements of grip strength, visual analog scale (VAS) pain scores, and Disabilities of the Arm, Shoulder and Hand (DASH) scores. Results: The mean preoperative VAS score in both groups was 6.8. Mean preoperative DASH scores were 61.1 in the arthroscopy group and 67.4 in the LRTI group. Postoperative VAS score at final follow-up was 4.8 in the arthroscopy group and 1.2 in the LRTI group ( P < .05). Postoperative DASH scores 9 months after surgery were 23 for the LRTI group and 55.2 for the arthroscopy group ( P < .05). Eight patients in the arthroscopy group had a second surgery due to persistent pain. Conclusions: Patients undergoing arthroscopic abrasion arthroplasty had high revision rates, higher postoperative pain, and lower patient-rated outcomes than patients undergoing LRTI procedure. The poor results in the arthroscopy group may be secondary to the inherent instability of the CMC joint and lack of use of any biological or artificial interposition material.

Sauve-Kapandji Remains a Viable Option for Distal Radioulnar Joint Dysfunction

Hand ◽  
2020 ◽  
pp. 155894472096672
Author(s):  
Nicholas Munaretto ◽  
William Aibinder ◽  
Steven Moran ◽  
Marco Rizzo
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
Distal Radioulnar Joint ◽  
High Rate ◽  
Wrist Flexion ◽  
Level Of Evidence ◽  
Radioulnar Joint ◽  
Major Complications ◽  
The Mean

Introduction Dysfunction of the distal radioulnar joint (DRUJ) can be significantly debilitating. The Sauve-Kapandji (S-K) procedure can be indicated to address multiple etiologies of DRUJ dysfunction. The purpose of this study was to review our institution’s results performing the S-K procedure for DRUJ dysfunction in terms of clinical and radiographic outcomes, as well as complications and reoperations. Methods A retrospective review of S-K procedures performed at 2 institutions between 1998 and 2017 with a minimum of 1-year follow-up was performed. Preoperative and postoperative visual analog scale (VAS) pain, grip strength, and wrist range of motion were reviewed. Radiographs were reviewed for DRUJ healing, carpal translation, and radiocarpal degenerative changes. Results The cohort included 35 patients. The mean age was 51 years. The mean follow-up was 49.5 months. The postoperative range of motion was unchanged in regard to pronation, supination, and wrist extension. There was a decrease in wrist flexion from 43 degrees to 34 degrees. Successful union was noted in 100% of the wrists. There was 1 case (2.8%) of progressive ulnar translation and 4 major complications (11.3%). Conclusion The S-K procedure has several theoretical benefits compared to other procedures for DRUJ dysfunction with results of this study demonstrating excellent pain relief, improved postoperative grip strength, retained wrist pronation, supination, and extension, high rate of successful arthrodesis and low rate of major complications. Level of Evidence Level IV

scholarly journals Outcomes of Surgical Management for Thumb Basilar Arthritis in Patients 55 Years of Age and Younger

Hand ◽  
2018 ◽  
Vol 14 (5) ◽  
pp. 641-645
Author(s):  
Peter C. Rhee ◽  
Aaron Paul ◽  
Brian Carlsen ◽  
Alexander Y. Shin
Keyword(s):  
Grip Strength ◽  
Revision Surgery ◽  
Pinch Strength ◽  
Subjective Outcome ◽  
Kaplan Meier ◽  
Postoperative Changes ◽  
The Mean ◽  
End Stage ◽  
Tendon Interposition

Background: Trapeziectomy with ligament reconstruction tendon interposition (LRTI) or suspensionplasty is an effective treatment in older patients with end-stage thumb basilar arthritis. However, the survivability of this procedure is unknown in younger patients who may impart more stress on their thumbs. Methods: A retrospective review was performed on all patients who underwent trapeziectomy and LRTI or suspensionplasty at 55 years of age or younger from 1992 to 2008. Objective clinical outcome measures included preoperative to postoperative changes in thumb range of motion, grip and pinch strength, a study-specific thumb function score, and the Buck-Gramcko subjective outcome score. Progressive metacarpal subsidence was evaluated on radiographs. Survivorship free from revision surgery was calculated with a Kaplan-Meier analysis. Results: A total of 57 wrists underwent trapeziectomy and LRTI (n = 18) or suspensionplasty (n = 39). The mean patient age at the time of surgery was 49.6 years (range: 38-55 years). Mean clinical and radiographic follow-up were 10.2 and 6.4 years, respectively. Overall, there were significant improvements in pain and grip strength despite progressive and metacarpal subsidence. Survivorship was 100% and 86% free from revision surgery at 10 and 15 years, respectively (n = 2 failures). Conclusions: Trapeziectomy and LRTI or suspensionplasty in patients less than or equal to 55 years of age can result in considerable improvements in pain and grip strength with a 10-year survivorship free from revision.

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