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Is a modified distraction arthroplasty without trapeziectomy effective for the advanced trapeziometacarpal osteoarthritis?
Chin-Hsien Wu, M.D.; Yuan-Kun Tu, M.D., Ph.D.
E-Da Hospital, Kaohsiung, Taiwan
Introduction: Distraction arthroplasty of the trapeziometacarpal (TMC) joint is a treatment option for patients with stage I-II TMC osteoarthritis. However, the indications of this technique have not been extended to stage III cases. The aim of this study was to analyze the outcome of stage III TMC osteoarthritis treated with modified distraction arthroplasty without trapeziectomy using the abductor pollicis longus tendon.
Materials & Methods: we retrospectively reviewed our electronic medical records and radiographs of patients who underwent modified distraction arthroplasty for stage III TMC osteoarthritis at an academic tertiary referral center from October 2012 to December 2024. Clinical outcomes and complications were evaluated.
Results: Twenty-four patients who suffered from stage III TMC osteoarthritis were enrolled in this study. The median visual analogue scale and the disabilities of the arm, shoulder and hand improved from 5 to 0 and 45.5 to 0, respectively. Hand grip and key pinch strength of the operated side both achieved 98% of functionality compared to the opposite side at latest follow up. No complications such as neuroma, complex regional pain syndrome or superficial sensory radial nerve injury were noted in the follow up. The radiographs showed the restoration of TMC joints regarding the joint space and alignment.
Conclusions: We found that the modified distraction arthroplasty could be an alternative option for patients who even suffered from advanced TMC osteoarthritis. Furthermore, the trapezium-sparing preserves the possibility of implant arthroplasty later. However, patients must be counseled that residual pain related to the ectopic bone may occur.
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