Comparative clinical study of 2 surgical techniques for trapeziometacarpal osteoarthritis

• Published in: Revista española de cirugía ortopédica y traumatología 2016-01, Vol.60 (1), p.59-66
• Main Authors: Martínez-Martínez, F, García-Hortelano, S, García-Paños, J P, Moreno-Fernández, J M, Martín-Ferrero, M Á
• Format: Article
• Language: eng ; spa
• Subjects: Aged; Arthroplasty - instrumentation; Arthroplasty - methods; Carpometacarpal Joints - surgery; Female; Follow-Up Studies; Humans; Joint Prosthesis; Male; Metacarpal Bones - surgery; Middle Aged; Osteoarthritis - surgery; Patient Satisfaction - statistics & numerical data; Patient Selection; Prospective Studies; Trapezium Bone - surgery; Treatment Outcome
• ISSN: 1988-8856; 1988-8856
• DOI: 10.1016/j.recote.2015.11.006

In trapeziometacarpal osteoarthritis (or rhizarthrosis), there is great controversy over the surgical technique to choose: simple trapeziectomy, resection-interposition arthroplasty, interposition arthroplasty suspension-or arthroplasty with implant or prosthesis. These latter 2 are the most used without consensus in the literature on the technique to choose and without sufficient comparative studies. The objective is to compare the 2 techniques most used today: suspension-interposition arthroplasty and arthroplasty with prosthesis. A prospective study was conducted on 15 patients diagnosed with grade 2-3 rhizarthrosis treated with interposition arthroplasty-suspension (group 1) and 15 with prosthesis (group 2) showing clinical outcomes, advantages and disadvantages of each. The study variables were the visual analogue scale (VAS), the DASH questionnaire, the grip strength, the strength of end to end and end-lateral clamp, the joint balance adduction-abduction and preemption-retropositioning, and the opposition. The 2 groups are from 2 different hospitals operated on by a hand surgeon from the Hand Unit. The follow-up time for all patients included in the study was 12 months. The VAS, DASH and grip strength at 12 months did not show significant differences. As regards the strength of end to end and end-lateral clamp, group 2 showed the highest values in all follow-up periods with statistically significant differences. Patient selection and surgical experience is essential, given the satisfactory results of both techniques. Arthroplasty prosthesis is reserved for grades 2 and 3, middle-aged patients, good trapezium architecture, and experienced surgeons.