Trapeziectomy for basal thumb osteoarthritis does not increase the risk of developing wrist osteoarthritis in the long term

Background Symptomatic osteoarthritis of the basal joint of the thumb (trapeziometacarpal joint) is a common disabling condition mainly affecting women. It is frequently treated with complete removal of the trapezium with or without soft-tissue interposition. There is limited evidence about whether removal of the trapezium affects stability of the wrist joint and increases the risk of developing wrist osteoarthritis. The aim of this study was to evaluate the long-term prevalence of OA in wrists with previous trapeziectomy compared to wrists with intact trapezium. Methods Patients treated with surgery for trapeziometacarpal osteoarthritis at one orthopedic department were invited 10–29 (mean 17) years postoperatively for bilateral radiographic examination. We included radiographs from 114 hands with trapeziectomy and 46 hands with intact trapezium; 38 patients had unilateral trapeziectomy and intact contralateral trapezium. The radiographs were blinded so that the intact trapezium or the trapezial space after trapeziectomy was not visible. The radiographs were then evaluated for radiocarpal/midcarpal osteoarthritis independently by two assessors using three different osteoarthritis grading systems, including the Kellgren–Lawrence classification. The patients rated their satisfaction with the function of each of their hands on a visual analog scale (VAS) from 0 to 100 (higher score better). Results The prevalence of osteoarthritis ranged from 20 to 26%, mostly mild (Kellgren–Lawrence grade 1). The prevalence of osteoarthritis did not differ between wrists with previous trapeziectomy and those with intact trapezium, both in the whole cohort and in the subgroup of patients with unilateral trapeziectomy and intact contralateral trapezium. There was no significant difference in hand function VAS scores between hands with previous trapeziectomy and hands with intact trapezium in the whole cohort or in the subgroup. Conclusions Removal of the trapezium as treatment for basal thumb osteoarthritis does not increase the risk of developing wrist osteoarthritis in the long term.

Prospective Evaluation of Low-Dose External Beam Radiotherapy (LD-EBRT) for Painful Trapeziometacarpal Osteoarthritis (Rhizarthrosis) on Pain, Function, and Quality of Life to Calculate the Required Number of Patients for a Prospective Randomized Study

Background: Retrospective studies have described the effectiveness of low-dose radiotherapy (LD-EBRT) in painful arthrosis of small finger joints, but two recent prospective studies have yielded ambiguous results. To generate accurate data for the planning of a trial, we conducted a prospective, monocentric, observational study to describe the effects of LD-EBRT as precisely as possible. Methods: Twenty-five consecutive patients with symptomatic trapeziometacarpal (TMC) arthrosis were irradiated with 6 × 0.5 Gy. Before, 3, and 12 months after LD-EBRT, we assessed subjective endpoints (modified “von-Pannewitz score”, 10-point visual analogue scale (VAS), “patient-rated wrist evaluation” (PRWE)), and objective measurements (“active range of motion” (AROM), Kapandji index, grip strength, pinch grip). Results: At 3/12 months, 80%/57% reported partial and 4%/18% complete remission according to the “von-Pannewitz” score. VAS “overall pain” significantly decreased from a median of seven (IQR 4) at baseline to three (IQR 6; p = 0.046) and to two (IQR 2; p = 0.013). Similar results were obtained for VAS “pain during exercise”, VAS “pain during daytime”, and VAS “function”. “PRWE overall score” was reduced from 0.5 at baseline (SD 0.19) to 0.36 (SD 0.24, p = 0.05) and to 0.27 (SD 0.18, p = 0.0009). We found no improvements of the objective endpoints (AROM, Kapandji, grip strength) except for flexion, which increased from 64° (SD 12°) at baseline to 73° (SD 9.7°, p = 0.046) at 12 months. Conclusions: We recommend the PRWE score as a useful endpoint for further studies for this indication. To prove a 15% superiority over sham irradiation, we calculated that 750 patients need to be prospectively randomized.

Mini TightRope Suspension Allows for Accelerated Rehabilitation following Ligament Reconstruction Interposition Arthroplasty of the Basal Joint of the Thumb

Introduction Surgical treatment of thumb trapeziometacarpal osteoarthritis usually involves 4 to 8 weeks of postoperative casting and splinting followed by varying mobilization protocols. Suspension arthroplasty has been described as an alternative to allow earlier range of motion exercises. The purpose of this study was to compare patient-reported outcomes (PRO) when adding a two-string suture-button suspension arthroplasty (Mini TightRope, MTR) to our usual procedure of ligament reconstruction and tendon interposition (LRTI), allowing early mobilization. Can we allow early mobilization using this technique without jeopardizing the PRO results at the 1 year follow-up and without an increased risk of complication? Materials and Methods A prospective study using the MTR system (Arthrex) as a suture-button suspensionplasty was conducted. Twelve patients (MTR group) and 36 historical patients (LRTI alone) were included. Results At 12 months, the median value for quick disabilities of the arm, shoulder, and hand was 11.3 (range, 0–43.2) in the MTR group and 13.6 (range, 0–88.6) in the LRTI group, resulting in similar improvements, p = 0.46. One in twelve patients in the MTR group was dissatisfied and 9 in 36 in the LRTI group were dissatisfied, p = 0.41. No complications were observed during the first year. Conclusion Supplemental suture-button suspensionplasty can be utilized for high demand patients and patients who want to reduce immobilization time without major complications and with similar PRO as LRTI at 6 and 12 months. Level of evidence Four case series

Outcomes of Revision of Interposition Implant Trapeziometacarpal Arthroplasty

Background Implant arthroplasties for trapeziometacarpal osteoarthritis are often associated with high complication and revision surgery rates. There are no previous studies reporting revision outcomes of failed interposition implant arthroplasty. Methods A patient register search was done for all implant arthroplasties performed for trapeziometacarpal osteoarthritis during a 10-year period in a single hand surgical unit. Altogether, 32 patients had primary interposition implant arthroplasty (Artelon 22, Pyrosphere 6, Ortosphere 2, and Pyrodisk 2), and 19 of these patients had revision surgery with 23 revision procedures performed. In all, 15 of the revised 19 patients were reexamined clinically (Connolly-Rath score, Quick Disabilities of the Arm Shoulder and Hand, patient evaluation measure, the visual analog score for pain, thumb range of motion and strength measurements) and radiographically. Results The indication for revision surgery was pain alone or implant dislocation accompanied by pain in all cases. Thirteen of the revised 15 patients reported functional deficit and pain after revision. There was no statistically significant difference in the revision outcomes between patients operated on primarily with the Artelon implant versus pyrocarbon/ceramic implants. Compared to previous studies on revision surgery and primary trapeziometacarpal arthroplasty, our results showed slightly higher pain and poorer functional scores. Conclusions Interposition implant arthroplasty may yield high revision rates. The results after revision surgery may be worse than previously described, and there may also be a tendency for worse results than those of primary arthroplasty. Interposition implant arthroplasty should always be thoroughly contemplated.