Basal joint arthroplasty using the Roosevelt Hospital techniques

Many reconstructive procedures have been developed to treat osteoarthritis of the basal joint of the thumb. The current article describes techniques used at the Hand Surgery Center at Roosevelt Hospital in New York City. A tonometry applanation radiographic staging system is outlined; it serves as a rationale for selecting which form of arthroplasty is appropriate for a particular patient and is predicated on the extent of involvement of the trapezial articulations. Stage 1 disease implies symptomatic laxity of the trapeziometacarpal joint with normal articular surfaces and is most appropriately treated with volar ligament reconstruction. Stage 2 is an intermediate category and amenable to either volar ligament reconstruction or interpositional arthroplasty of the trapeziometacarpal joint, based on the condition of the articular cartilage at surgery. In stage 3 disease there are significant degenerative changes of the trapeziometacarpal joint with preservation of the articular surfaces of the scaphotrapezial joint. Two variations on ligament reconstruction with interpositional arthroplasty of the trapeziometacarpal joint are described; they have consistently good results. Finally, stage 4 is characterized by pantrapezial degenerative disease and necessitates trapezial resection. Reconstruction may be by silicone rubber implant arthroplasty using a stemmed trapezial implant stabilized by an abductor pollicis longus tenodesis. The alternative is a procedure in which the thumb metacarpal is tethered to the index metacarpal by a ligament reconstruction.