Biomechanical Test of Three Methods to Treat Thumb CMC Arthritis

Abstract

Background Basilar thumb arthritis, or first carpometacarpal arthritis, is a common condition, predominantly affecting women. Surgical treatment of this condition is highly varied. One common method consists of trapezium excision and a concomitant procedure for treatment of the “floating” thumb metacarpal. That procedures vary suggests that no method has an “outcome” advantage over another. However, the frequency of side effects is higher in more complex procedures.

Question/Purposes We speculated that in vitro testing might identify a potential outcome difference that has been difficult to measure in vivo. Since the more complex procedure to treat this condition has a higher frequency of clinical side effects, we hoped to determine its functional value compared with less complex procedures.

Methods A two-degrees-of-freedom biomechanical cadaver study examined simulated pinch strength and metacarpal subsidence during pinch. Three methods were compared with each other and against the normal pretreatment state: trapezial excision alone; trapezial excision and suture suspensionplasty (TESS); and trapezial excision followed by a ligament reconstruction using one-half of the flexor carpi radialis and tendon interposition (LRTI).

Results After TESS, the loaded mean height of the arthroplasty space was 1.20 cm. This was statistically less than the pretreatment height of 1.50 cm (P < 0.05). However, the height maintained after LRTI (1.00 cm) was also statistically less than pretreatment state (P < 0.05) and less than TESS (P < 0.05). Trapezial excision alone was least successful at maintaining height. In contrast, the mean key pinch measured after treatment could not be predicted by treatment employed.

Conclusions In summary, the tested technique of TESS appears to be biomechanically sound as related to maintenance of first metacarpal height. In in vitro testing it is superior to excision alone and at least equal to the ligament reconstruction method tested. Analysis of our data shows that 96% of the overall height (distance) maintained post excision is explained by surgical state.

Clinical Relevance Trapezial height is preserved using support schemes in a laboratory setting. In the in vivo postsurgical state, clinical intrinsic muscle function may be superior when support is used compared with trapeziectomy alone.

Keywords

Basilar thumb arthritis - first carpometacarpal (1st CMC) arthritis - in-vitro testing - biomechanical cadaver study - trapezial excision

Note

This study was performed in the Biomechanics Laboratory at the University of Minnesota under the direction of Jack Lewis, PhD. Portions of this work were previously presented in poster format as the ASSH Annual Meeting (2000) and in podium presentation format at the AAOS Annual Meeting (2006).

• References

• 1 Armstrong AL, Hunter JB, Davis TR. The prevalence of degenerative arthritis of the base of the thumb in post-menopausal women. J Hand Surg [Br] 1994; 19 (3) 340-341
• 2 Fulton DB, Stern PJ. Trapeziometacarpal arthrodesis in primary osteoarthritis: a minimum two-year follow-up study. J Hand Surg Am 2001; 26 (1) 109-114
• 3 Putnam MD, Chapman J. Interpositional titanium hemiarthroplasty for trapezial metacarpal arthritis. Atlas Hand Clin 1997; 2: 203-216
• 4 Jones NF, Maser BM. Treatment of arthritis of the trapeziometacarpal joint with trapeziectomy and hematoma arthroplasty. Hand Clin 2001; 17 (2) 237-243
• 5 Kuhns CA, Emerson ET, Meals RA. Hematoma and distraction arthroplasty for thumb basal joint osteoarthritis: a prospective, single-surgeon study including outcomes measures. J Hand Surg Am 2003; 28 (3) 381-389
• 6 Atroshi I, Axelsson G. Extensor carpi radialis longus tendon arthroplasty in the treatment of primary trapeziometacarpal arthrosis. J Hand Surg Am 1997; 22 (3) 419-427
• 7 Burton RI, Pellegrini Jr VDJ. Surgical management of basal joint arthritis of the thumb. Part II. Ligament reconstruction with tendon interposition arthroplasty. J Hand Surg Am 1986; 11 (3) 324-332
• 8 Dell PC, Brushart TM, Smith RJ. Treatment of trapeziometacarpal arthritis: results of resection arthroplasty. J Hand Surg Am 1978; 3 (3) 243-249
• 9 Gibbons CE, Gosal HS, Choudri AH, Magnussen PA. Trapeziectomy for basal thumb joint osteoarthritis: 3- to 19-year follow-up. Int Orthop 1999; 23 (4) 216-218
• 10 Kriegs-Au G, Petje G, Fojtl E, Ganger R, Zachs I. Ligament reconstruction with or without tendon interposition to treat primary thumb carpometacarpal osteoarthritis. A prospective randomized study. J Bone Joint Surg Am 2004; 86-A (2) 209-218
• 11 Lins RE, Gelberman RH, McKeown L, Katz JN, Kadiyala RK. Basal joint arthritis: trapeziectomy with ligament reconstruction and tendon interposition arthroplasty. J Hand Surg Am 1996; 21 (2) 202-209
• 12 Thompson J. Suspensionplasty technique. Atlas Hand Clin 1997; 2: 101-125
• 13 Wajon A, Ada L, Edmunds I. Surgery for thumb (trapeziometacarpal joint) osteoarthritis. Cochrane Database Syst Rev 2005; (4) CD004631
• 14 Giurintano DJ, Hollister AM, Buford WL, Thompson DE, Myers LM. A virtual five-link model of the thumb. Med Eng Phys 1995; 17 (4) 297-303
• 15 Cooney III WP, An KN, Daube JR, Askew LJ. Electromyographic analysis of the thumb: a study of isometric forces in pinch and grasp. J Hand Surg Am 1985; 10 (2) 202-210
• 16 Brand PW, Beach RB, Thompson DE. Relative tension and potential excursion of muscles in the forearm and hand. J Hand Surg Am 1981; 6 (3) 209-219
• 17 Barber FA, Herbert MA, Click JN. The ultimate strength of suture anchors. Arthroscopy 1995; 11 (1) 21-28
• 18 Bamford D, Page RE. Ligament reconstruction in tendon interposition arthroplasty of the trapezium. J Hand Surg [Br] 1990; 15 (3) 387-388
• 19 Meunier MJ, Hentzen E, Ryan M, Shin AY, Lieber RL. Predicted effects of metacarpal shortening on interosseous muscle function. J Hand Surg Am 2004; 29 (4) 689-693