Partial trapeziectomy with ligament reconstruction--tendon interposition in thumb carpo-metacarpal osteoarthritis. A study of 112 cases.

INTRODUCTION: We have performed arthroligamentoplasty with partial trapeziectomy since 1987. We compare the results of this technique with those of arthroligamentoplasty with total trapeziectomy.

MATERIAL AND METHODS: We reviewed 112 arthroligamentoplasties performed by the same surgeon, with a minimum follow-up of three years, comparing partial trapeziectomy (93 hands Eaton stage II-III of the disease and one with post-traumatic osteoarthritis), with total trapeziectomy (nine hands stage IV of the disease, eight hands requiring re-operation due to failure of total trapeziectomy and one with post-traumatic osteoarthritis).

RESULTS: Pain: all the patients have improved. Slight pain at moderate effort persisted in three cases (17%) of total trapeziectomy and in 14 cases (15%) of partial trapeziectomy but only one of these required revision surgery with arthrodesis. Key-Pinch strength: partial trapeziectomy: strength averaged 93% of preoperative strength. In the 34 bilaterally affected cases, the operated hand had 110% of the strength of the non-operated contralateral hand. Total trapeziectomy: strength averaged 85% of preoperative values. In the seven bilateral affection cases, the operated hand had 105% of the strength of the non-operated contralateral hand. Range of motion: we did not register relevant differences. Radiology: in relation to preoperative period, we registered 18% reduction of the scapho-metacarpal space associated with partial trapeziectomy, and 29% in scapho-metacarpal space associated with total trapeziectomy.

COMPLICATIONS: we have registered complications in 12 hands.

CONCLUSION: Both techniques resulted in indistinguishable outcomes. Given the goal of preventing the impairment of a healthy joint and a very hazardous surgical alternative in case of failure, the indication for total trapeziectomy should be restricted to the presence of damage in the two major surfaces of the trapezium.