Trapezio-metacarpal arthritis: functional and radiographic results at an average 5-year follow-up using trapeziectomy associated to a modified Ceruso’s suspensionplasty.

Trapezio-metacarpal arthritis: functional and radiographic results at an average 5-year follow-up using trapeziectomy associated to a modified Ceruso’s suspensionplasty.

Authors

  • Chiara Concina Orthopaedics and Traumatology Unit, Ospedale San Polo, Monfalcone (GO)
  • Marina Crucil Orthopaedics and Traumatology Unit, Ospedale San Polo, Monfalcone (GO)
  • Giorgio Saggin Orthopaedics and Traumatology Unit, Ospedale San Polo, Monfalcone (GO)
  • Franco Gherlinzoni Orthopaedics and Traumatology Unit, Ospedale San Polo, Monfalcone (GO)

Keywords:

suspensionplasty, trapezio-metacarpal arthritis, trapeziectomy, arthroplasty

Abstract

Background and aim: Trapezial-metacarpal arthritis (TMA) is a common and highly disabling pathology. Trapeziectomy and Ceruso’s suspensionplasty is described for moderate-severe stages. The aim of the present study was to assess functional and radiographic results at an average 5-year follow-up using a modified Ceruso’s technique where the Abductor Pollicis Longus (APL) is passed twice around the Flexor Carpi Radialis (FCR) and a suture mini-anchor in the base of the first metacarpal is used to further stabilize the thumb.

Methods: 85 consecutive modified Ceruso’s suspensionplasty were performed from 2012 and 2018. All the patients were evaluated at an average 5.1-year follow-up (21-96 months). Subjective patient satisfaction rate, NRS, DASH score, abduction angle, Kapandji score and pinch strength using functional tests were assessed. The scapho-metacarpal distance was measured at follow-up radiographs.

Results: 90.6% of the patients were satisfied by the treatment. The NRS and the DASH score improved (from 8.5 pre-operatively to 1.53 and from 87.5 to 24.6 respectively-p<0.001). The Kapandji test was rated from 7 to 10 in 65.9% of the patients. The pinch strength was good in 75.3% of the patients at follow-up. The abduction angle of the thumb was 38.2° (20°-55°). The mean scapho-trapezial distance decreased of 2.45 mm (from 9.87 mm to 7.42 mm - p<0.05). 8 patients had persistent pain and thumb disfunction, 1 patient had De Quervain’s tenosynovitis.

Conclusions: Suspensionplasty according to Ceruso’s is a relatively simple and reproducible technique for moderate-severe TMA. It improves pain and thumb function, giving good stability without significant shortening.

References

Raven EE, Kerkhoffs GM, Rutten S, Marsman AJ, Marti RK, Albers GH. Long term results of surgical intervention for osteoarthritis of the trapeziometacarpal joint: comparison of resection arthroplasty, trapeziectomy with tendon interposition and trapezio-metacarpal arthrodesis. Int Orthop 2007; 31 (4): 547-54.

Armstrong AL, Hunter JB, Davis TR. The prevalence of degenerative arthritis of the base of the thumb in post-menopausal women. J Hand Surg Br 1994; 19 (3) :340-1.

Gomes Carreira AC, Jones A, Natour J. Assessment of the effectiveness of a functional splint for osteoarthritis of the trapeziometacarpal joint on the dominant hand: a randomized controlled study. J Rehabil Med 2010; 42 (5): 469-74.

Gervis WH. Excision of the trapezium for osteoarthritis of the trapezio-metacarpal joint. Postgrad Med J 1948; 24 (271): 262-4.

Ceruso M, Innocenti M, Angeloni R, Lauri G, Bufalini C. L’artrosi del 1° raggio digitale. Riv Chir Mano 1991; 28: 67-75

Welby A. Tendon interposition arthroplasty of the first carpometacarpal joint. J Hand Surg 1988; 31B: 421-5

Eaton RG, Littler JW. Ligament reconstruction for the painful thumb carpometacarpal joint. J Bone Joint Surg Am 1973; 55 (8): 1655-66.

Kapandji IA. Clinical evaluation of the thumb’s opposition. J Hand Ther 1992; 2: 102-106

Gervis WH, Wells T. A review of excision of the trapezium for osteoarthritis of the trapezio-metacarpal joint after twenty-five years. J Bone Joint Surg Br 1973; 55 (1): 56-7.

Yeoman TFM, Stone O, Jenkins PJ, McEachan JE. The long-term outcome of simple trapeziectomy. J Hand Surg Eur Vol 2019; 44 (2): 146-50.

Noland SS, Saber S, Endress R, Hentz VR. The scaphotrapezial joint after partial trapeziectomy for trapeziometacarpal joint arthritis: long-term follow-up. J Hand Surg Am 2012; 37 (6): 1125-9.

Lucet A, Ligeard M, Salle de Chou E, Hulet C, Malherbe M. Arthroscopic treatment of basal joint arthritis by partial trapeziectomy with ligament reconstruction: Short-term results from a prospective study of 20 patients. Hand Surg Rehabil 2019; 38 (2): 102-7.

Brown GD 3rd, Roh MS, Strauch RJ, Rosenwasser MP, Ateshian GA, Mow VC. Radiography and visual pathology of the osteoarthritic scaphotrapezio-trapezoidal joint, and its relationship to trapeziometacarpal osteoarthritis. J Hand Surg Am 2003; 28 (5): 739-43.

Froimson AI. Tendon arthroplasty of the trapeziometacarpal joint. Clin Orthop Relat Res 1970; 70: 191-9.

Logli AL, Twu J, Bear BJ, Lindquist JR, Schoenfeldt TL, Korcek KJ. Arthroscopic Partial Trapeziectomy With Soft Tissue Interposition for Symptomatic Trapeziometacarpal Arthritis: 6-Month and 5-Year Minimum Follow-Up. J Hand Surg Am 2018; 43 (4): 384.e1-e7.

Rhee PC, Shin AY. Complications of trapeziectomy with or without suspension arthroplasty. J Hand Surg Am 2014; 39 (4): 781-3.

De Maio F, Farsetti P, Potenza V, Petrungaro L, Marsiolo M, Caterini A. Surgical treatment of primary trapezio-metacarpal osteoarthritis by trapeziectomy and ligament reconstruction without tendon interposition. Long-term results of 50 cases. J Orthop Traumatol 2019; 20 (1): 25.

Tomaino MM. Suspensionplasty for basal joint arthritis: why and how. Hand Clin 2006; 22 (2): 171-5.

Internullo G. La rizoartrosi: trattamento con artroplastica di sospensione secondo Ceruso nei gradi avanzati [Trapeziometacarpal joint osteoarthritis: treatment with tendon interposition arthroplasty according to Ceruso in severe osteoarthritis]. Reumatismo 2008; 60 (2): 125-30

Pegoli L, Prashanth S, Calcagni M, Pivato G, Pajardi G. The surgical treatment of the first carpometacarpal joint arthritis: evaluation of 400 consecutive patients treated by suspension arthroplasty. Hand Surg 2005; 10 (2-3): 199-203

Lins RE, Gelberman RH, McKeown L, Katz JN, Kadiyala RK. Basal joint arthritis: trapeziectomy with ligament reconstruction and tendon interposition arthroplasty. J Hand Surg Am 1996; 21 (2): 202-9.

Naram A, Lyons K, Rothkopf DM, Calkins ER, Breen T, Jones M, Shufflebarger JV. Increased Complications in Trapeziectomy With Ligament Reconstruction and Tendon Interposition Compared With Trapeziectomy Alone. Hand (N Y) 2016;11 (1): 78-82.

Li YK, White C, Ignacy TA, Thoma A. Comparison of trapeziectomy and trapeziectomy with ligament reconstruction and tendon interposition: a systematic literature review. Plast Reconstr Surg 2011;128 (1): 199-207.

Belcher HJ, Nicholl JE. A comparison of trapeziectomy with and without ligament reconstruction and tendon interposition. J Hand Surg Br 2000; 25 (4): 350-6.

Turker T, Thirkannad S. Trapezio-metacarpal arthritis: The price of an opposable thumb! Indian J Plast Surg 2011; 44 (2): 308-16.

Downloads

Published

30-12-2020

How to Cite

1.
Concina C, Crucil M, Saggin G, Gherlinzoni F. Trapezio-metacarpal arthritis: functional and radiographic results at an average 5-year follow-up using trapeziectomy associated to a modified Ceruso’s suspensionplasty. Acta Biomed [Internet]. 2020 Dec. 30 [cited 2024 Jul. 18];91(14-S):e2020026. Available from: https://mattioli1885journals.com/index.php/actabiomedica/article/view/10976