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Arthroscopic Partial Trapeziectomy with Soft Tissue Interposition for Symptomatic Trapeziometacarpal Arthritis
Theodore Schoenfeldt BS1, Anthony Logli BA1, Jonathan Twu MD2, Brian Bear MD1,3, Jonathan Lindquist BS1, Ken Korcek MD1,3
11University of Illinois College of Medicine at Rockford, Rockford, IL, 2University of Chicago Hospitals, Rockford, IL, 3OrthoIllinois, Rockford, IL
Objective: To determine if arthroscopic partial trapeziectomy and soft tissue interposition arthroplasty is an effective treatment for symptomatic trapeziometacarpal arthritis.
Methods: We retrospectively evaluated 30 consecutive patients with symptomatic trapeziometacarpal arthritis, Eaton-Littler stage 2 and 3. Treatment consisted of an arthroscopic partial trapeziectomy; arthroscopic resection arthroplasty (ARA) with soft tissue interposition utilizing an acellular dermal matrix as the interposition material. We evaluated a pre-operative and post-operative Numeric Pain Rating Scale (NPRS), patient reported satisfaction, post-operative grip strength, appositional pinch strength, oppositional pinch strength, post-operative arthroplasty space and QuickDASH scores. The follow-up was performed at a mean of 1 year and 6 years after surgery.
Results: At 1 year follow-up, 30 of 30 patients reported a reduction in pain. Pre-operative NPRS averaged 8.2 and decreased to an average of 1.2 after surgery (p < .00). 27 of 30 patients were satisfied with the result. QuickDASH scores improved from 44 to 19 after surgery. 29/30 thumbs adducted fully in the plane of the palm and opposed the fifth metacarpal head. Post-operative grip, oppositional pinch and appositional pinch strength were 97%, 93% and 85% of the contralateral hand, respectively. 24 patients were available for 6 year follow-up. NPRS average was 0.75. 22 of 24 patients were satisfied with the procedure. QuickDASH average was 17.5. Thumb motion, pinch and grip strength were not statistically different at 1 and 6 years follow-up. Complications were rare.
Conclusion: Arthroscopic partial trapeziectomy with interposition arthroplasty utilizing an acellular dermal matrix as the interpostion material is a safe procedure that provides adequate pain relief, patient satisfaction, thumb motion and strength at 6 year follow-up. Pain relief, motion and function do not significantly change between 1 and 6 years follow-up.
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