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Clinical and Radiographic Outcomes of Simultaneous Unilateral Basal Joint Arthroplasty and Scaphoidectomy with Four-Corner Fusion
Erik White, MD; Martin Skie, MD; Margaret Jain, MD
University of Toledo, Toledo, OH

Introduction: Basal joint arthritis of the thumb and wrist arthritis are frequently treated with surgical intervention upon failure of conservative management. Not infrequently, patients will present with coexisting, symptomatic basal joint and wrist arthritis requiring surgical intervention. There is no current standard of care for these patients. It has become our practice to offer basal joint arthroplasty in the form of ligament reconstruction and tendon interposition (LRTI) along with scaphoidectomy and four-corner fusion at a single surgical intervention.
Methods: A retrospective case series was performed of patients who underwent simultaneous LRTI and scaphoidectomy with four-corner fusion for advanced basal joint and wrist arthritis respectively. Preoperative and postoperative visual analog scale (VAS) pain scores, postoperative active wrist flexion and extension, time to radiographic fusion, and first metacarpal subsidence (referenced from second metacarpal-trapezoid joint) were recorded.
Results: 6 patients and a total of 7 wrists were identified. The average age at time of surgery was 67 years (51-81). There were 4 males, 2 females. 4 out of 7 operative wrists were in the dominant extremity. The average operative time was 169 minutes (90-230). A 1-2 metacarpal pin was placed in 4 of 7 wrists according to surgeon preference. The average follow up was 12 months (3-64). Average time to radiographic fusion of midcarpal arthrodesis was 15.6 weeks (9-34). VAS scores decreased from an average of 8.3 (5-10) to 3.3 (0-8). Average postoperative flexion and extension were 37.6o (10-50) and 34.9o(10-45) respectively. Postoperative first metacarpal subsidence was an average of 6.3mm (3.9-10.9). No patients noted functional impairment from metacarpal height loss. Complications were a result of the arthrodesis hardware: 2 patients underwent loose screw removal; and another had the plate removed due to extensor tenosynovitis.
Conclusion: Simultaneous unilateral basal joint arthroplasty and scaphoidectomy may be performed safely in a single operative setting in the context of concomitant wrist and thumb arthritis. Patient outcomes demonstrate decreased pain with preserved wrist motion and metacarpal height. When compared to the historic studies, first metacarpal subsidence in these patients is similar to that of patients who undergo LRTI alone, despite the absence of the scaphoid.

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