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Outcome of Trapeziectomy and Ligament Reconstruction and Tendon Interposition for Patients Aged Less Than 56 Years: A
Iman Hameed1, Ellen Tomkinson2, Omer Slevin3
1Hand Surgery Unit, Department of Plastic Surgery, St Vincent's Hospital, Melbourne, Australia.
Insights
Trapeziectomy with ligament reconstruction and tendon interposition (LRTI) effectively treats trapeziometacarpal osteoarthritis in patients under 56. However, long-term outcomes show a decline in function and increased pain with time since surgery.
Area of Science:
- Orthopedic surgery
- Hand surgery
- Osteoarthritis treatment
Background:
- Trapeziometacarpal osteoarthritis significantly impacts hand function.
- Surgical interventions like trapeziectomy with ligament reconstruction and tendon interposition (LRTI) are common treatments.
- Evaluating long-term outcomes in specific patient demographics is crucial for treatment optimization.
Purpose of the Study:
- To assess the long-term consequences of trapeziectomy and LRTI for trapeziometacarpal osteoarthritis.
- To specifically evaluate outcomes in patients younger than 56 years at the time of surgery.
Main Methods:
- Retrospective study of patients under 56 who underwent trapeziectomy and LRTI.
- Follow-up period exceeding 5 years.
- Utilized patient-reported outcomes (DASH, PRWE, VAS) and objective measures (strength, range of motion, radiographic assessment).
Main Results:
- Mean follow-up was 11 years in 48 patients (58 thumbs).
- Younger age correlated with increased metacarpal migration.
- Higher pain scores (VAS) linked to poorer functional scores (PRWE, DASH) and reduced strength.
- Longer follow-up intervals correlated with increased pain and functional decline.
Conclusions:
- Trapeziectomy and LRTI demonstrate effectiveness in younger (<56 years) patients with trapeziometacarpal osteoarthritis.
- Surgical benefits must be weighed against the observed long-term functional decline and increasing pain over time.
Purpose:
The purpose of this study was to determine the long-term consequences of trapeziectomy and ligament reconstruction and tendon interposition (LRTI) for trapeziometacarpal osteoarthritis in patients aged less than 56 years.
Methods:
A retrospective study was performed to investigate the outcome of trapeziectomy and LRTI with a follow-up period of greater than 5 years in patients aged less than 56 years at the time of surgery. Patients completed the Disabilities of Arm, Shoulder, and Hand (DASH), the Patient-Rated Wrist Evaluation (PRWE), and a 10-point visual analog score for pain (VAS). Objective assessments included thumb opposition, palmar and radial abduction angles, and grip, lateral key, and thumb tip pinch strengths. Radiographic assessments of the thumb carpometacarpal joint were performed in three planes, and the trapezial space and trapezial space to metacarpal height ratios were calculated.
Results:
Between January 2005 and December 2017, 105 patients were treated. Forty-eight patients with 58 thumbs returned for review. The mean patient age at the time of surgery was 52.5 years, and 96% of the patients were women. The mean follow-up period from surgery was 11 years. The mean VAS score was 1. A significant association was found between younger age at the time of surgery and increased proximal migration of the metacarpal, between high VAS pain scores and high PRWE and DASH scores, weak grip, lateral key pinch and thumb tip pinch strength, and Kapandji score, and between the follow-up period and increasing VAS pain, PRWE, and DASH scores.
Conclusions:
Trapeziectomy and LRTI are effective procedures for patients aged less than 56 years. The benefits of surgery should be balanced against the deterioration in the outcome measures of DASH and PRWE and increasing VAS scores with increasing intervals from surgery.
Type Of Study/Level Evidence:
Therapeutic IV.