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Increased Risk of Complications in Trapeziectomy with Ligament Reconstruction and Tendon Interposition Compared with Trapeziectomy Alone
Aparajit Naram, MD; Keith Lyons; John Shufflebarger, MD
UMass Medical School, Worcester, MA
Introduction: In the treatment of basal joint arthritis of the thumb, recent studies suggest long term outcomes are equivalent with regard to long term pain, mobility, and strength, in patients either undergoing trapeziectomy alone or trapeziectomy with ligament reconstruction and tendon interposition (LRTI)1,2. The goal of this study was to investigate risk factors for complications in carpometacarpal (CMC) arthroplasty. These risk factors include type of operation performed, age, smoking, diabetes, and the use of Kirschner wire (k-wire) intraoperatively.
Materials and Methods: We conducted a retrospective chart review of five surgeons at a single institution who had performed CMC arthroplasties from November 2006-November 2012. A total of 200 thumbs in 179 patients underwent either simple trapeziectomy with or without k-wire stabilization, or trapeziectomy and LRTI with or without k-wire stabilization. The average follow up was 11.6 months (range 1-69 months). Data collection included patient demographics, operation type, medical history, and outcomes involving any adverse events, paying attention to those necessitating reoperation, antibiotics, or those who developed complex regional pain syndrome.
Results: Seventy hands had a post-operative complication. Ten of these complications were considered major, defined as requiring antibiotics, reoperation, or other major interventions. Minor complications included pain, swelling, stiffness, paresthesias, symptomatic subsidence, and symptomatic tendonitis. Of 126 thumbs receiving LRTI, 52 (41%) developed complications, 7 (6%) of which were considered major, and 45 (36%) of which were considered minor. LRTI is associated with an increased risk for total complications (RR=1.69, P=0.02). Additionally we found an increased risk for minor complications (RR=1.76, P=0.03), but no statistically significant increase in risk for major complications. Further, no statistically significant association was found with regard to smoking, diabetes, age, or use of k-wire as risk factors for complications.
Conclusions: Patients undergoing trapeziectomy with LRTI have an increased incidence of overall complications when compared with trapeziectomy alone. These results suggest an advantage of simple trapeziectomy in providing equivalent long term outcomes with fewer complications. Larger studies are required to identify smoking, diabetes, patient age, or use of k-wire intraoperatively as statistically significant risk factors for complications.
1. Gangopadhyay S, McKenna H, Burke FD, Davis TR. Five- to 18-year follow-up for treatment of trapeziometacarpal osteoarthritis: a prospective comparison of excision, tendon interposition, and ligament reconstruction and tendon interposition. J Hand Surg Am. Mar 2012;37(3):411-417.
2. Nilsson A, Wiig M, Alnehill H, et al. The Artelon CMC spacer compared with tendon interposition arthroplasty. Acta Orthop. Apr 2010;81(2):237-244.
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