Arthrosopic Resection Arthroplasty for Basal Joint Arthritis: Comparing Outcomes for Isolated Trapeziometacarpal versus Trapeziometacarpal and Scaphotrapeziotrapezoid Resection

Purpose: To evaluate the difference in outcomes following arthroscopic resection arthroplasty (ARA) for isolated trapeziometacarpal (TM) disease versus simultaneous ARA of TM and scaphotrapeziotrapezoid (STT) for pantrapezial disease.

Materials and Methods: Data were prospectively collected on 178 cases of ARA for thumb basal joint OA between 2004 and 2011. Data were collected preoperatively and postoperatively at 1, 3, 6, and 12 months and annually thereafter. Occupational therapists measured pain (0–10), pinch, and grip. Patient satisfaction was evaluated at final follow-up (0 = dissatisfied, 5 = satisfied). Patients were excluded if they had less than 1-year follow-up or underwent concomitant surgical procedures that would obscure determination of the variables of interest.

Confounding variables at a significance level of p < 0.05 were adjusted for in linear mixed models, and an analysis of covariance was employed through an unstructured type of variance-covariance matrix.

Results: Mean follow-up was 6.5 years (range 4–10). Baseline data are shown in Table 1. Changes in outcome are shown in Table 2. Hand dominance, work comp, work type, and preop symptom length significantly affected outcomes and were controlled for in analyses. Raw and adjusted data (corrected for confounding variables) show no statistical difference when comparing ARA for isolated TM versus simultaneous ARA of TM and STT for pain, pinch, and grip. Mean tourniquet time for the TM group was 19 minutes (SD = 9.5) and 28 minutes (SD = 8.1) minutes for the pantrapezial group. Mean final satisfaction was 4.57 and 4.62 for TM and pantrapezial groups, respectively. There were four (5%) failures in the TM and two (5%) in the pantrapezial group.

Conclusions: Although resecting both the TM and STT joints is a more extensive procedure, concurrent resection of both joints yields the same results as isolated CMC ARA, suggesting that patients with questionable STT involvement should be treated to avoid the potential need for future STT ARA.

Table 1 Baseline characteristic of patients who underwent arthroscopic resction arthroplasty

Demographic	TM (n = 84)	TM and STT (n = 41)	Total (n = 125)
Gender
Male, n (%)	19 (23)	9 (22)	28 (22)
Female, n (%)	65 (77)	32 (78)	97 (78)
Age-mean (range)	57 (35–82)	63 (45–83)	60 (35–83)
Dominant side involved, n (%)	42 (50)	23 (56)	65 (52)
Work comp cases, n (%)	14 (17)	7 (17)	21 (17)
Pain, mean (range)	6.29 (1–10)	6.60 (3–10)	6.40 (1–10)
Pinch (kg), mean (range)	4.67 (0–17)	4.69 (0–11)	4.68 (0–17)
Grip (kg), mean (range)	21.33 (0–46)	20.39 (5–45)	21.02 (0–46)

Table 2 Mean changes in adjusted pain, pinch, and grip scores

Changes in outcomes from preoperative to final follow-up (Minimum 1-year)	TM (n = 84)	TM and STT (n = 41)	TM vsTM and STT
	Mean (SD)	Mean (SD)	P value	(95% CI)
Change in pain (pre- to postop) (kg)	–5.59 (1.6)	–5.46 (1.5)	0.09	(–0.93, 0.07)
Change in pinch (kg)	1.45 (2.4)	1.36 (1.9)	0.76	(–1.54, 1.12)
Change in grip (kg)	4.30 (11.5)	2.66 (9.3)	0.12	(–1.19, 10.29)