Hematoma Distraction Arthroplasty after Trapeziectomy in Advanced Osteoarthritis of the Trapeziometacarpal Joint

Bo-Kun Kim; Hyun-Dae Shin; Kyung-Cheon Kim; Soo-Min Cha

doi:10.4055/jkoa.2012.47.1.21

Journal List > J Korean Orthop Assoc > v.47(1) > 1013151

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Kim, Shin, Kim, and Cha: Hematoma Distraction Arthroplasty after Trapeziectomy in Advanced Osteoarthritis of the Trapeziometacarpal Joint

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2012; 47(1): 21-27.

Published online: 29 February 2012

DOI: https://doi.org/10.4055/jkoa.2012.47.1.21

Hematoma Distraction Arthroplasty after Trapeziectomy in Advanced Osteoarthritis of the Trapeziometacarpal Joint

Bo-Kun Kim, M.D., Hyun-Dae Shin, M.D., Ph.D.^*, Kyung-Cheon Kim, M.D., Ph.D.^*, Soo-Min Cha, M.D.^*

Department of Orthopedic Surgery, Dong-A University School of Medicine, Busan, Korea.

^*Department of Orthopedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea.

Correspondence to: Hyun-Dae Shin, M.D., Ph.D. Department of Orthopedic Surgery, Chungnam National University School of Medicine, 640, Daesa-dong, Jung-gu, Daejeon 301-721, Korea. TEL: +82-42-280-7349, FAX: +82-42-252-7098, hyunsd@cnu.ac.kr

Received 3 February 2011 Revised 9 May 2011 Accepted 5 October 2011

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the clinical usefulness of hematoma distraction arthroplasty to treat advanced trapeoziometacarpal osteoarthritis of the thumb.

Materials and Methods

We studied 12 cases (1 male, 11 females) with osteoarthritis of the thumb that was managed with hematoma distraction arthroplasty using K-wire fixation. Of the 12 cases, 7 were Littler-Eaton stage III and 5 were Littler-Eaton stage IV. We investigated operation time, preoperative and postoperative visual analogue scale (VAS) score, preoperative and postoperative range of motion, grip power and radiologic changes.

Results

The mean patient age was 53.2 (39-61) years and the mean duration of follow-up was 19.5 (14-27) months. The average operation time was 52 minutes. The mean VAS scores at 6 and 12 months after the operation were 1.3 and 0.7, respectively. The range of motion and grip power of the finger improved postoperatively (15% in abduction, 18% in adduction, 25% in flexion, 14% in extension, 66% in grip power of the finger). On a simple 12-month postoperative radiologic exam, the interval between the scaphoid and first metacarpal bone had decreased 6.5 mm compared with the preoperative interval.

Conclusion

The surgical treatment using hematoma distraction arthroplasty for trapeziometacarpal osteoarthritis is an effective method for pain relief, improvement of motion range and finger-grip power.

Keywords: trapeziometacarpal joint, osteoarthritis, hematoma distraction arthroplasty

Figures and Tables

Figure 1

JAMAR® hand dynamometer (Preston, Jackson, MI, USA).

Figure 2

This graph shows preoperative and postoperative Scaphoid-thumb metacarpal distances at rest. Preop, preoperative; Postop #6 m, postoperative at 6 month; Postop #12 m, postoperative at 12 month.

Figure 3

A 55-year-old female who was diagnosed with advanced trapeziometacarpal joint osteoarthritis in Littler-Eaton stage III. (A) preoperative radiographs, (B) postoperative radiographs, (C) last follow-up radiographs (postoperative 12 months), (D) excised trapezium at the operation.

Table 1

Distribution of Sex and Littler-Eaton Stage

Table 2

Comparison of Preoperative and Postoperative VAS Scores

VAS, visual analogue scale; Preop, preoperative; Postop, postoperative; M, male; F, female.

Table 3

Data of Preoperative and Postoperative Range of Motion and Grip Power of Fingers in This Study

^*Abd, abduction; ^†Add, adduction; ^‡Flex, flexion; ^§Ext, extension; ^∥FU 12 m, postoperative follow up at 12 months. ROM, range of motion; Preop, preoperative; Postop, postoperative; FU, follow up.

Table 4

Summary of Preoperative and Postoperative Results of Relatively Younger (A) and Older (B) Age Groups

References

1. Amadio PC, Millender LH, Smith RJ. Silicone spacer or tendon spacer for trapezium resection arthroplasty--comparison of results. J Hand Surg Am. 1982. 7:237–244.

2. Burton RI, Pellegrini VD Jr. Surgical management of basal joint arthritis of the thumb. Part II. Ligament reconstruction with tendon interposition arthroplasty. J Hand Surg Am. 1986. 11:324–332.

3. Conolly WB, Rath S. Revision procedures for complications of surgery for osteoarthritis of the carpometacarpal joint of the thumb. J Hand Surg Br. 1993. 18:533–539.

4. Davis TR, Brady O, Dias JJ. Excision of the trapezium for osteoarthritis of the trapeziometacarpal joint: a study of the benefit of ligament reconstruction or tendon interposition. J Hand Surg Am. 2004. 29:1069–1077.

5. Dell PC, Brushart TM, Smith RJ. Treatment of trapeziometacarpal arthritis: results of resection arthroplasty. J Hand Surg Am. 1978. 3:243–249.

6. Kuhns CA, Emerson ET, Meals RA. Hematoma and distraction arthroplasty for thumb basal joint osteoarthritis: a prospective, single-surgeon study including outcomes measures. J Hand Surg Am. 2003. 28:381–389.

7. Fulton DB, Stern PJ. Trapeziometacarpal arthrodesis in primary osteoarthritis: a minimum two-year follow-up study. J Hand Surg Am. 2001. 26:109–114.

8. Muller GM. Arthrodesis of the trapezio-metacarpal joint for osteoarthritis. J Bone Joint Surg Br. 1949. 31:540–542.

9. Froimson AI. Tendon arthroplasty of the trapeziometacarpal joint. Clin Orthop Relat Res. 1970. 70:191–199.

10. Herndon JH. Trapeziometacarpal arthroplasty. A clinical review. Clin Orthop Relat Res. 1987. (220):99–105.

11. Athwal GS, Chenkin J, King GJ, Pichora DR. Early failures with a spheric interposition arthroplasty of the thumb basal joint. J Hand Surg Am. 2004. 29:1080–1084.

12. Trumble TE, Rafijah G, Gilbert M, Allan CH, North E, McCallister WV. Thumb trapeziometacarpal joint arthritis: partial trapeziectomy with ligament reconstruction and interposition costochondral allograft. J Hand Surg Am. 2000. 25:61–76.

13. Iyer KM. The results of excision of the trapezium. Hand. 1981. 13:246–250.

14. Minami A, Iwasaki N, Kutsumi K, Suenaga N, Yasuda K. A long-term follow-up of silicone-rubber interposition arthroplasty for osteoarthritis of the thumb carpometacarpal joint. Hand Surg. 2005. 10:77–82.

15. Swanson AB. Disabling arthritis at the base of the thumb: treatment by resection of the trapezium and flexible (silicone) implant arthroplasty. J Bone Joint Surg Am. 1972. 54:456–471.

16. Eaton RG, Lane LB, Littler JW, Keyser JJ. Ligament reconstruction for the painful thumb carpometacarpal joint: a long-term assessment. J Hand Surg Am. 1984. 9:692–699.

17. Dell PC, Muniz RB. Interposition arthroplasty of the trapeziometacarpal joint for osteoarthritis. Clin Orthop Relat Res. 1987. (220):27–34.

18. Kessler I. Silicone arthroplasty of the trapezio-metacarpal joint. J Bone Joint Surg Br. 1973. 55:285–291.

19. Gerwin M, Griffith A, Weiland AJ, Hotchkiss RN, McCormack RR. Ligament reconstruction basal joint arthroplasty without tendon interposition. Clin Orthop Relat Res. 1997. (342):42–45.

20. Kriegs-Au G, Petje G, Fojtl E, Ganger R, Zachs I. Ligament reconstruction with or without tendon interposition to treat primary thumb carpometacarpal osteoarthritis. A prospective randomized study. J Bone Joint Surg Am. 2004. 86:209–218.

21. Tomaino MM, Pellegrini VD Jr, Burton RI. Arthroplasty of the basal joint of the thumb. Long-term follow-up aft er ligament reconstruction with tendon interposition. J Bone Joint Surg Am. 1995. 77:346–355.

22. Dhar S, Gray IC, Jones WA, Beddow FH. Simple excision of the trapezium for osteoarthritis of the carpometacarpal joint of the thumb. J Hand Surg Br. 1994. 19:485–488.

23. Gervis WH, Wells T. A review of excision of the trapezium for osteoarthritis of the trapezio-metacarpal joint after twenty-five years. J Bone Joint Surg Br. 1973. 55:56–57.

24. Gervis WH. Excision of the trapezium for osteoarthritis of the trapezio-metacarpal joint. J Bone Joint Surg Br. 1949. 31:537–539.

25. Gray KV, Meals RA. Hematoma and distraction arthroplasty for thumb basal joint osteoarthritis: minimum 6.5-year follow-up evaluation. J Hand Surg Am. 2007. 32:23–29.

26. Yang SS, Weiland AJ. First metacarpal subsidence during pinch after ligament reconstruction and tendon interposition basal joint arthroplasty of the thumb. J Hand Surg Am. 1998. 23:879–883.

TOOLS

Similar articles