[Lundborg's resection arthroplasty vs. Pyrocarbon spacer (Pyrocardan®) for the treatment of trapeziometacarpal joint osteoarthritis: a two-centre study].

Background Various operative approaches exist for osteoarthritis of the trapeziometacarpal joint. The aim of this two-centre study was to compare the results of Lundsborg's resection arthroplasty with the implantation of the Pyrocardan(®) spacer. Patients and methods We treated 20 patients with symptomatic osteoarthritis of the trapeziometacarpal joint in stage III / IV (Eaton-Littler classification). Twelve patients received Lundsborg's resection arthroplasty (centre 1), and in 8 patients a Pyrocardan(®) spacer was implanted (centre 2). Both groups were comparable regarding patients´ age, the preoperative pain level, the osteoarthritis stage according to Eaton-Littler, and the duration from the onset of symptoms until surgery. Patient data were retrospectively collected from patient records, and we performed a follow-up examination at least 18 months postoperatively, thereby evaluating the DASH sore, the postoperative time until freedom of symptoms, the pain level according to the visual analogue scale, grip force (Jamar dynamometer), pinch force, and patients' treatment satisfaction (0-10; 10 = highest satisfaction). Results Both groups had a similar length of follow-up with 23.6 ± 5.2 months for the resection group and 26.1 ± 4.0 months for the spacer group. The duration of the operation was 31 ± 5 min for the resection group and 29 ± 7 min for the spacer group (p > 0.05). The DASH score was 21.9 ± 6.2 in the resection group and 18.3 ± 5.0 in the spacer group (p > 0.05). The pain level at the current follow-up was 1.5 ± 0.83 in the spacer group and 1.0 ± 0.74 in the resection group (p > 0.05). The time until freedom of symptoms was significantly shorter in the spacer group with 3.7 ± 1.9 months compared to the resection group with 5.7 ± 3.1 months (p = 0.0001). Grip force and pinch force were not significantly different between both groups. Treatment satisfaction was 9.3 ± 1.6 in the resection group and 7.4 ± 3.0 in the spacer group (p > 0.05). Conclusion Over a follow-up period of 1.5 years, both techniques resulted in a satisfactory usability of the operated hand and a clear reduction of symptoms. The implantation of the Pyrocardan(®) spacer seems to have slight advantages regarding a shorter time until freedom of symptoms. However, the implantation of the spacer is associated with additional material costs of a few hundred Euros, which are not incurred in resection arthroplasties. The implantation of the Pyrocardan(®) spacer seems to have slight advantages regarding a shorter time until freedom of symptoms.