Long-Term Clinical and Radiological Outcome Following Partial Trapeziectomy and Capsular Interposition for the Treatment of Thumb Carpometacarpal Joint Arthritis

Purpose: To present the long-term outcome of our published surgical technique of partial trapezial and metacarpal excision with capsular interposition (partial trapeziectomy and capsular interposition; PTCI).¹

Materials: This is an institutional review board (IRB)-approved study. Twenty-three patients (28 thumbs) who underwent surgical treatment with PTCI for osteoarthritis of the carpometacarpal (CMC) joint of the thumb were invited to return for follow-up (mean 62.25 months). All surgeries were performed by the primary author. All clinical examinations were performed by two hand fellows. Follow-up clinical examinations included measures of grip and pinch, web space, and metacarpophalangeal (MCP) range of motion (ROM). All measures were compared with the preoperative values. Three X-ray views of the hand were obtained. Measurements of the trapezial space ratio (TSR; normalized to proximal phalanx) and joint subluxation (normalized to metacarpal base) were done by research faculty and compared with the preoperative values. Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and visual analog scale (VAS) results are reported.

Results: The average preoperative grip was 22 kg-force and the average postoperative grip was 26.6 kg-force with 21% improvement. There was no significant improvement in pinch. The first web space was maintained at 4 cm. The MCP ROM was +17/42° preoperatively and + 25/33° postoperatively. There was a nonsignificant increase of TSR (0.448 ± 0.039 versus 0.456 ± 0.071; p = 0.285). There was a significant reduction in subluxation (0.54 ± 0.11 versus 0.45 ± 0.14; p = 0.002). Three patients were not included in the DASH evaluation because of nonrelated health problems. Four patients reported some pain, and the others had no pain. The average DASH score for the remaining 19 patients was 4.0, and the average VAS was 1.75 of 10.

Conclusions: The long-term results of our procedure indicate a stable thumb with good outcomes both clinically and radiologically. The procedure is simpler than other complex procedures that require tendon harvest or prosthetic replacement.

References

Reference

1 Moneim MS, Morrell NT, Mercer DM. Partial trapeziectomy with capsular interposition arthroplasty (PTCI): a novel technique for thumb basal joint arthritis. Tech Hand Up Extrem Surg 2014;18(3):116–120