Combined Treatment of Basal Thumb Arthritis and Scapholunate Advanced Collapse Wrist
Grzegorz Kwiecien, MD1, Mark Hendrickson, MD2, William H Seitz Jr, MD3, Peter J. Evans, MD, PhD3, Antonio Rampazzo, MD, PhD4 and Bahar Bassiri Gharb, MD, PhD5, (1)Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, (2)Department of Plastic Surgery, The Cleveland Clinic Foundation, Cleveland, OH, (3)Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, (4)Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH, (5)Plastic Surgery, Cleveland Clinic, Cleveland, OH
Combined treatment of trapeziometacarpal osteoarthritis (OA) and SLAC wrist presents unique challenges. The consequences of loss of radial column support caused by scaphoidectomy, common to all procedures for stages 2 and 3 SLAC wrist, and trapeziectomy are not well known. We hypothesized that simultaneous treatment of the first carpometacarpal joint OA and SLAC wrist will result in increased complication rate when compared to staged treatment.
MATERIALS AND METHODS:
An IRB approved retrospective review of patients who underwent surgery for both trapeziometacarpal OA and SLAC wrist between 2003 and 2017 at the Cleveland Clinic Health System. Postoperative outcomes including range of motion (ROM), grip and pinch strengths, validated quality of life questionnaires Quick-DASH and AM-PAC were analyzed.
A total of 1638 patients treated for wrist arthritis were identified. Twenty-two patients who underwent both trapeziectomy with LRTI and one of the three procedures for SLAC wrist (four-corner fusion (N=10), proximal row carpectomy (N=7), and wrist replacement (N=5)) in a single stage (N=10) or two-stage (N=12) were included. Mean age was 62years (range: 39-80). Mean follow-up was 46.3months (range: 12-187). Twelve patients underwent complete scaphoidectomy (55%) and 10 patients underwent partial scaphoidectomy (45%). Mean range of wrist motion was: flexion 22.2¡ (range: 0-40), extension 37.2¡ (range: 0-65), radial deviation 10.6¡ (range: 0-20), and ulnar deviation 18.1¡ (range: 0-20¡). Mean Kapandji score was 8.0 (range: 3-10), thumb palmar abduction 36.2¡ (range: 20-41), and thumb radial abduction 36.0¡ (range: 15-45). Mean grip strength was 17.1kg (range: 9.5-27.4), lateral pinch 3.5kg (range 1.1-5.4), and tripod pinch 2.8kg (range: 1.6-4.1). The overall VAS score for pain at rest and during activity showed significant improvement after both procedures (Δ-2.1 and Δ-5.8, respectively; p<0.05). The mean Quick DASH and AM-PAC scores showed significant improvement (p<0.01) and were comparable to patients undergoing staged treatment (p>0.05). There were no significant differences in ROM between patients undergoing partial versus complete scaphoidectomy. However, patients with preserved distal scaphoid had significantly higher grip and pinch strengths (p<0.05). One patient had a four-corner fusion collapse and underwent wrist arthrodesis. There were no other failures or revision procedures. Radiological analysis revealed no other complications.
Trapeziometacarpal OA and SLAC wrist may be treated either simultaneously or staged. Trapeziectomy and LRTI with the preservation of the distal pole of scaphoid results in better grip and pinch strength. Partial preservation of the scaphoid should be considered when planning for subsequent trapezium resection.
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