EXCISION OF THE TRAPEZIUM FOR THUMB CARPOMETACARPAL OSTEOARTHRITIS- SIMPLE TRAPEZIECTOMY OR WITH SOFT TISSUE RECONSTRUCTION?

Abstract

Carpometacarpal arthritis of the thumb is a common source of morbidity particularly in post-menopausal women. It is commonly and successfully treated by trapeziectomy with or without ligament reconstruction and tendon interposition. This randomised prospective study compared the results of trapeziectomy alone or combined with tendon interposition and ligament reconstruction in 125 patients. Each patient had subjective and objective assessment of thumb pain, stiffness and strength and were scored using the D.A.S.H. and P.E.M. scoring systems. Patients were assessed pre-operatively and at 3 months and 1 year after surgery. The results of the two procedures revealed statistically improved pain levels but there was no statistically significant difference between the two in terms of pain relief, stiffness, weakness, grip strength, keypinch and thumb key pinch as well as in the D.A.S.H. and P.E.M. scores. The study shows that in the short term soft tissue reconstruction in addition to a simple trapeziectomy provides no improved benefit to the patient.