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The Effect of Pre-Operative MCP Hyperextension on Functional Outcomes After Basilar Thumb Arthroplasty
David M Brogan, MD, MSc1; Sanjeev Kakar, MD2
1University of Missouri, Columbia, MO; 2Mayo Clinic, Rochester, MN
Purpose: In the surgical treatment of thumb carpometacarpal (CMC) joint arthritis, the effect of mild pre-operative metacarpophalangeal (MCP) hyperextension on post-operative functional outcomes is unknown. We sought to examine outcomes after surgical treatment of CMC arthritis in patients with and without mild pre-existing MCP deformity.
Methods: A retrospective review was conducted analyzing the functional outcomes of patients treated for CMC arthritis from March of 1998 to May of 2009. Assessments included pinch & grip strength, degree of MCP hyperextension and thumb radial and palmar abduction. Statistical analyses used included t-test assuming unequal variances.
Results: A total of 203 patients were followed for an average of 27.2 months. Patients were divided into two groups: 1) Patients without pre-operative MCP hyperextension (167 pts); 2) Patients with mild but untreated pre-operative MCP hyperextension (<= 30 deg) (36 pts). All patients underwent either a Weilby procedure (118 pts) or a ligament reconstruction tendon interposition (LRTI) (85 pts). Analysis of the pre-operative data showed no difference in the baseline parameters among both groups, with the exception of MCP hyperextension. No patient in Group 1 had any pre-operative hyperextension, and the average pre-operative hyperextension deformity in Group 2 was 13.4 degrees, with a range of 3 to 30 degrees (Figure 1). Post-operatively, there were no significant differences in key pinch, tip pinch, grip strength and radial or palmar abduction of the thumb. Both groups showed improved pinch strength and thumb radial and palmar abduction after surgery (Table 1). Group 1 showed an improvement in grip between pre and post-operative measurements, while Group2 showed a slight decrease in grip strength, however the differences between Group 1 and 2 was not statistically significant.
Conclusion: While patients in both groups showed uniform improvement in almost all functional parameters after surgery, there were no statistically significant differences in improvement when comparing patients without pre-operative MCP hyperextension to patients with mild pre-operative MCP hyperextension.
Table 1
Figure 1 Amount of Pre-Operative Hyperextension in Group 2
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