METHODOLOGY FOR THE ANALYSIS OF OUTCOMES IN THE ROSELAND PROSTHESIS FOR THE TREATMENT OF OSTEOARTHRITIS

Abstract

Introduction: Osteoarthritis of the thumb basal joint is a very common and disabling condition that frequently affects middle-aged women, sometimes bilaterally. The purpose of this work is to present the methodology of the preoperative and postoperative assessment carried out in 52 patients who underwent a trapeziometacarpal joint replacement procedure (Roseland prosthesis).

Material and Methods: Total joint arthoplasty of the trapeziometacarpal joint was performed on 52 thumbs in 44 patients (15 dominants hands) to treat osteoarthritis (Eaton-Littler stages II and III) between 1995 and 2007. 18 patients were missed for follow-up purposes. Average age of 59,4 years. The Roseland trapeziometacarpal joint prosthesis was used in this study. We analyzed the ROM for abduction-adduction, flexo-extension of the trapeziometacarpal joint and the opposition of the thumb by the modified Kapandji test. We also measured radiographic distance of the TMC space in preoperative radiographies and compared it with the postoperative ones. Finally, strength was quantified for the lateral, tip-to-tip, and tridigital pinch in the treated hands. Pain was measured with VAS and the DASH questionnaire was completed by all the patients. The average follow-up period was of 5,3 years (range, 1,1–12,1 years).

Results: At the final follow-up visit we obtained the following Results: for thumb abduction average 66°, thumb opposition to the base of the smaller finger was present in 58%, and thumb flexo-extension average 59°. The average tip-to-tip pinch strength was 2,7, for the lateral pinch 3,6 and for the tridigital pinch was 3,7. We observed that in 36% of the radiographies the TMC space was the same pre and postoperative. Average VAS and DASH scores were of 1,6 and 26,3 respectively. Five patients (10%) needed a revision surgery (2 for infection and 3 for aseptic loosening of the prosthesis)

Conclusions: Most of the protocols evaluating surgical outcomes on the trapeziometarcarpal joint don’t allow a functional analysis of ROM and strength of this joint. That’s why we developed the idea of designing a new methodology, that we currently use in our centre, to analyze the functional outcome of the surgery on the trapeziometacarpal joint. We specially recommend the measurement of the tridigital pinch strength, as is the most representative feature of the hand function.