Six year outcome excision of the trapezium for trapeziometacarpal joint osteoarthritis: is it improved by ligament reconstruction and temporary Kirschner wire insertion?

Abstract

This randomized prospective study compared the treatment of trapeziometacarpal joint osteoarthritis with a) trapeziectomy with no ligament reconstruction, no soft tissue interposition and no temporary Kirschner wire stabilization (Group T); b) trapeziectomy with flexor carpi radialis ligament reconstruction and interposition and temporary K-wire stabilization (Group T+LRTI). We followed 99 patients with 114 thumbs (59 T and 55 T+LRTI) for a mean of 6.2 (range, 4.2-8.1) years. There were no significant differences between the two treatments in any subjective or objective outcome measure at 6 year follow-up. Eighty-two percent of the thumbs were painless or only ached after use. The DASH (Group T mean, 31; 95% CI, 26-42: Group T+LRTI mean 30; 95% CI, 22-35) and Patient Evaluation Measure (Group T mean, 35; 95% CI, 29-41: Group T+LRTI mean 34; 95% CI, 27-39) scores were significantly better than preoperatively. Thumb key pinch strength did not differ significantly between the two treatment groups (Group T mean 3.7 kg: 95% CI, 3.3-4.2: Group T+LRTI mean 4.1 kg, 95% CI, 3.7-4.7) and was not significantly different from the preoperative key pinch strength. This study does not provide evidence to support the use of LRTI and temporary K-wire stabilization after trapeziectomy.