Simple Trapeziectomy Sufficient For Thumb Osteoarthritis


NEW YORK — Simple trapeziectomy offers as much benefit as more complicated, combined procedures for osteoarthritis of the trapeziometacarpal joint, Timothy R.C. Davis, M.D., said at the annual meeting of the American Society for Surgery of the Hand.

Trapeziectomy has been widely performed for this condition since its use was first reported in 1949. It fell out of favor because it was perceived as having a protracted recovery, and there was a belief that the inevitable shortening of the thumb would weaken that digit.

Concerns about postoperative arthritis or instability that could lead to persistent pain led to modifications of the procedure, Dr. Davis said.

One approach was to do a tendon interposition after trapeziectomy, using the palmaris longus. A second alternative was to do the tendon interposition plus an additional ligament reconstruction, which is probably the most commonly used technique today, he said.

“But neither of these procedures has ever been demonstrated to produce better outcomes than simple excision of the trapezium,” said Dr. Davis, professor of orthopaedics and accident surgery at the University of Nottingham (England).

A series of 183 thumbs in 162 women whose painful basal thumb osteoarthritis had not responded to medical therapy were randomized to one of the three procedures.

Additional procedures such as carpal tunnel decompressions were performed as necessary. Following the surgery, each thumb was immobilized in a plaster of paris spica for 6 weeks.

Once the plaster was removed patients were encouraged to mobilize the thumb and were given physiotherapy as needed.

Subjective assessments included evaluation of pain, weakness, stiffness, and the ability to perform activities of daily living.

At 3 months about 50% of patients in all groups reported little or no pain, and by 1 year, 82% had reached this level of pain relief. “But the pain relief was not influenced by the type of operation—it was as if we had done the same operation in all the patients,” Dr. Davis said.

By 1 year, 68% reported no weakness or interference with activities of daily living.

Mean thumb key pinch strength, evaluated with a pinch meter, improved significantly across all groups from 3.5 kg preoperatively to 4.6 kg at 1 year, but again the improvement was not influenced by the type of surgery performed, he said.

“In the short term at least, we concluded that palmaris longus interposition or ligament reconstruction did not improve the outcome of simple trapeziectomy with the insertion of a Kirschner wire and did not speed up recovery from the operation,” Dr. Davis said.

Five-year follow-up is ongoing, but the results will have to wait until about 2007, he added.