Total trapeziectomy

Targeted partial arthroscopic trapeziectomy with temporary distraction: a retrospective study with 5-year follow-up

Targeted partial arthroscopic trapeziectomy with temporary distraction is a minimally invasive treatment for trapeziometacarpal osteoarthritis. We performed a retrospective single centre study from March 2011 to May 2022 and included patients with at least 5 years of follow-up. A failure was defined as a patient requiring a second procedure. Of the 28 patients with at least 5 years of follow-up, 23 were reviewed. Five of the 23 patients underwent revision surgery with a 5-year survival rate of 78%. There was a significant improvement in pain and the Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score. There were three postoperative complications, one with complex regional pain syndrome, and two with hyperesthesia in the distribution of the sensory branch of the radial nerve. Targeted partial arthroscopic trapeziectomy with temporary distraction is a feasible temporary solution for early stage trapeziometacarpal joint osteoarthritis. However, there remains a 20% risk of failure.Level of evidence: IV.

Thumb basal joint arthritis: new classification, diagnostic and therapeutic algorithm

The assessment of thumb basal joint arthritis requires a radiographic evaluation and a classification of the lesions to guide the treatment choice. Arthritis of the thumb basal joint is not limited to trapeziometacarpal arthritis. The radiographic assessment must consider the scaphotrapeziotrapezoid joint, the entire carpus and the rest of the thumb column, in particular the metacarpophalangeal joint. There is currently no classification that captures all these items. This article reviews the existing classifications, proposes a new classification system that takes into account the entire thumb column and sets out the therapeutic options.

Trapeziectomy with suture-button suspensionplasty versus ligament reconstruction and tendon interposition: a randomized controlled trial

The purpose of the present study was to compare the results of patients operated with trapeziectomy and ligament reconstruction and tendon interposition (LRTI) using flexor carpi radialis tendon versus trapeziectomy followed by suspension of the first metacarpal to the second metacarpal using a Mini TightRope® suture button (suture button suspension: SBS). A single-center prospective randomized controlled trial was performed, comparing 37 patients with SBS and 39 with LRTI. All surgeries were performed by the same fellowship-trained hand surgeon. Patients were assessed by an independent observer at 40 months' follow-up. Pre- and postoperative strength, trapezial space ratio (TSR), range of motion, QuickDASH and visual analogue pain score were recorded. Both procedures improved functional parameters of pain, key strength, tip strength and grip strength while maintaining range of motion, without significant differences. In the SBS group, TSR decreased by 17%, compared to 28% in the LRTI group. The mean operative time was shorter in SBS (63 vs 91 minutes; p < 0.0001), as was immobilization time (2 vs 6 weeks; p < 0.0001), and patients resumed normal activity sooner (10 vs 12 week; p = 0.0138) and required less physical therapy (19.3 vs 13.1 weeks; p < 0.0001). We believe that our results are related to the hypothesis suggested by biomechanical studies that revealed better initial load bearing profile and maintenance of trapezial space following serial loading in cadaver models.