Thumb carpometacarpal osteoarthritis: Arthrodesis compared with ligament reconstruction and tendon interposition

Background: There has been considerable controversy regarding the procedure of choice for treatment of any given stage of osteoarthritis of the thumb carpometacarpal joint. This study was designed to directly compare the clin ical results of two common surgical procedures for this condition, trapezio metacarpal arthrodesis and trapezial excision with ligament reconstruction and tendon interposition, in similar patient populations. Methods: Between 1988 and 1998, 109 patients (141 thumbs) who were less tha n sixty years old were treated with one of the two procedures. In a retrosp ective review, forty-two patients (fifty-eight thumbs) treated with arthrod esis completed an outcome questionnaire and twenty-nine patients (forty-fou r thumbs) treated with arthrodesis completed the questionnaire and were exa mined. In the group treated with trapezial excision with ligament reconstru ction and tendon Interposition, thirty-nine patients (forty-nine thumbs) co mpleted the questionnaire and thirty patients (thirty-eight thumbs) complet ed the questionnaire and were examined. The average duration of followup wa s sixty-nine months. The groups were similar with regard to age, gender, ha nd dominance, and duration of follow-up. Results: Subjective evaluation of pain, function, and satisfaction demonstr ated no significant difference between the two groups, with >90% of patient s satisfied following either procedure. Although grip strength did not diff er between the groups, the arthrodesis group had significantly stronger lat eral pinch (p < 0.001) and chuck pinch (p < 0.01). The group treated with l igament reconstruction and tendon interposition had a better range of motio n with regard to opposition (p < 0.05) and the ability to flatten the hand (p < 0.0001). There was a higher complication rate in the arthrodesis group , with nonunion of the fusion site accounting for the majority of the compl ications. However, despite a persistent nonunion in six thumbs, those thumb s and the thumbs in which union was obtained did not differ with regard to. pain; all. of the patients with nonunion had improvement in their pain sta tus compared with. preoperatively, and all were very satisfied with the out come. Peritrapezial arthritis developed in nine patients (fourteen thumbs). This finding was not related to age and did not affect overall pain, funct ion, or satisfaction. Conclusions: Although traditionally arthrodesis and ligament reconstruction and tendon interposition have been indicated in two different patient popu lations, we compared them in a homogeneous group and found that the two pro cedures had similar results with regard to pain, function, and satisfaction despite minimal differences in strength and motion. Although complications were more frequent following arthrodesis, most did not affect the overall outcome.