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ARTHROPLASTY FOR TRAPEZIUM EXCISION AND TENDON INTERPOSITION IN RHIZARTHROSIS CASES: PROSPECTIVE STUDY
Walter Gomes Pinheiro Junior1, Renan Moukbel Chaim2, Henrique Bella Freire de Carvalho2
1Former Specialization Student in the Discipline of Hand and Upper Limb Surgery, Department of Orthopedics and Traumatology, Paulista School of Medicine, UNIFESP.
Objective:
To prospectively evaluate the results from a series of patients who underwent surgical treatment for rhizarthrosis using the technique of trapezium resection associated with interposition of yarn from the long abductor tendon of the thumb.
Methods:
From May to August 2005, ten patients underwent surgical treatment for rhizarthrosis. Patients with primary osteoarthrosis of the trapezium-metacarpal joint, in stages II, III and IV of the Eaton classification, with persistent pain that was refractory to clinical treatment, were included. For the functional assessment, the visual analogue scale, DASH questionnaire and Buck-Gramcko score were used. For the overall assessment on the patients, strength measurements were made for palm grip, pulp to pulp pinch, lateral pinch, three-point pinch, opposition and radial and palmar abductions. The migration index for the first metacarpal was also determined on radiographs at rest and under stress.
Results:
The pain relief was considered to be good (p = 0.005), with functional improvements in modules 2 (p = 0.02) and 3 (p = 0.022) of DASH. The Buck-Gramcko score showed one excellent and three very good results. There was an improvement in almost all of the overall assessment and was only non-significant regarding lateral pinch and abduction. For all patients, there was migration of the first metacarpal.
Conclusion:
Trapeziectomy associated with interposition of yarn from the long abductor tendon of the thumb was shown to be a relatively simple and effective technique for pain relief and functional improvement.
