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Incidence of Carpal Instability and Mid- to Long-Term Outcomes after Trapeziectomy and Partial Trapezoidectomy for Concomitant Thumb Carpometacarpal and Scaphotrapeziotrapezoid Osteoarthritis
Meredith R Flanagan, BS
1; Christopher M Gibbs, MD
2; Jessica B Hawken, MD
3; Trenton M Gause II, MD
4; Robert J Goitz, MD
51University of Pittsburgh Medical Center, Pittsburgh, PA; 2Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC; 3MedStar Health, Alexandria, VA; 4Tri Rivers Musculoskeletal Centers, Mars, PA; 5Orthopaedic Surgery, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
Introduction: We aimed to investigate mid-to-long-term outcomes in patients undergoing trapeziectomy and partial trapezoidectomy for scaphotrapeziotrapezoid (STT) and thumb carpometacarpal (CMC) joint arthritis. Prior literature has suggested that trapeziectomy with partial trapezoidectomy may lead to carpal instability. However, long-term outcomes of this procedure are needed to determine the risk of potential postoperative instability. We hypothesize that patients undergoing trapeziectomy and partial trapezoidectomy will not display radiographic evidence of DISI at long-term follow-up.
Materials & Methods: Patients with thumb CMC and concomitant STT osteoarthritis who underwent carpometacarpal arthroplasty with concurrent hemitrapezoidectomy between 2004 and 2021 were included. At follow-up, a clinical evaluation was performed to assess postoperative satisfaction, presence of pain, pinch and grip strength, thumb range of motion and qDASH hand scores. Standard PA and lateral wrist radiographs were also obtained. DISI was defined as an SL angle greater than 60°.
Results: Thirty-two patients participated in the study, 28 women and 4 men, with a total of 43 wrists assessed (women = 38, men = 5). The mean years since surgery was 7.7 years (range 1.2 - 18.8). Preoperative radiographic data was available for 16 wrists, 4 of which possessed preoperative carpal instability with an SL angle greater than 60°. Of the 43 wrists assessed in the study, 9 wrists (21%) displayed an SL angle greater than 60° and therefore possessed radiographic evidence of carpal instability (DISI) post-operatively. Ninety-eight percent of patients reported satisfaction with their procedure, 95% reported that they would have the procedure again, and 88% reported no pain at their follow-up assessment.
Conclusions: While the literature suggests that patients with concomitant STT arthritis may have a higher incidence of DISI post-operatively, the current study suggests that patients undergoing trapeziectomy with partial trapezoidectomy for concomitant CMC and STT joint arthritis do not exhibit dissatisfaction at mid- to long-term follow-up. Furthermore, this study found that the rate of carpal instability was 21% at mid- to long-term follow-up, suggesting that the rate of carpal instability may be lower than that previously reported in the literature. Well maintained patient satisfaction at mid- to long-term follow-up among both patients with evidence of DISI and without evidence of DISI suggests that development of DISI deformity does not seem to correlate to poor patient reported outcomes or satisfaction. Further investigation into alternative factors that may contribute to understanding why some patients have poor outcomes after CMC arthroplasty with concomitant STT arthroplasty is needed.
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