Original ArticleNo Access

Arthrodesis for Primary Osteoarthritis of Trapeziometacarpal Joint Using Multiple Kirschner Wires and Tension Band Wire in Female Patients Older than 40

Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Ogori, Yamaguchi, Japan

Correspondence to: Yasunori Hattori, Department of Orthopedic Surgery, Ogori Daiichi General Hospital, 862-3, Shimogo, Ogori, Yamaguchi-City Yamaguchi-Prefecture 754-0002, Japan, Tel: +81-839-72-0333, Fax: +81-839-73-4909.

Search for more papers by this author

Kota HAYASHI

Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Ogori, Yamaguchi, Japan

Search for more papers by this author

Dawn Sinn Yii CHIA

Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Ogori, Yamaguchi, Japan

Search for more papers by this author

Sotestu SAKAMOTO

Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Ogori, Yamaguchi, Japan

Search for more papers by this author

, and

Kazuteru DOI

Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Ogori, Yamaguchi, Japan

Search for more papers by this author

https://doi.org/10.1142/S2424835522500539Cited by:3 (Source: Crossref)

Abstract

Background: The purpose of this study was to evaluate the results of arthrodesis with multiple Kirschner (K)-wires and tension band wire for primary osteoarthritis of trapeziometacarpal (TM) joint in female patients aged 40 years or older.

Methods: We retrospectively obtained data regarding all female patients 40 years or older who underwent TM joint arthrodesis for TM joint osteoarthritis with K-wires and tension band wire over a 10-year period from 2009 till 2019. Thumb length, active range of motion (ROM) at the metacarpophalangeal (MCP) joint, active ROM of radial and volar adduction and abduction and key pinch strength was measured. Patient-reported outcomes were assessed using a pain and satisfaction questionnaire and the DASH score. We also recorded postoperative complications.

Results: The study included 60 thumbs in 49 patients with an average age 60 years and a mean follow-up of 40 ± 21 months. All but one thumb had radiographic evidence of fusion within 6 months and the union rate was 98%. Key pinch strength increased from 2.3 to 4.9 kg after surgery. Total arc of motion in radial adduction–abduction decreased from 16° to 10°. Total arc of motion in volar adduction–abduction decreased from 25° to 9°. One patient experienced attritional rupture of the flexor pollicis longus tendon attributed to a K-wire penetration into the carpal tunnel. Although 46 thumbs (77%) had no or mild hardware-related symptoms, they underwent hardware removal after solid bone union. In 23 thumbs with follow-up period longer than 48 months, two thumbs developed scaphotrapeziotrapezoid joint arthritis and two thumbs developed metacarpophalangeal joint arthritis.

Conclusions: We found that arthrodesis with multiple K-wires and tension band wire is a valuable option in the management of trapeziometacarpal joint osteoarthritis in female patients aged 40 years or older.

Level of Evidence: Level IV (Therapeutic)

Keywords:

REFERENCES

1. Eaton RG, Littler JW. Ligament reconstruction for the painful thumb carpometacarpal joint. J Bone Joint Surg Am. 1973;55(8):1655–1666. Crossref, Medline, Google Scholar
2. Wilson JN, Bossley CJ. Osteotomy in the treatment of osteoarthritis on the first carpometacarpal joint. J Bone Joint Surg Br. 1983;65(2):179–181. https://doi.org/10.1302/0301-620X.65B2.6826626. Crossref, Google Scholar
3. Braun RM. Total joint replacement at the base of the thumb-preliminary report. J Hand Surg Am. 1982;7(3):245–251. Crossref, Medline, Google Scholar
4. Cooney WP, Linsheid RL, Askew LJ. Total arthroplasty of the thumb trapeziometacarpal joint. Clin Orthop. 1987;(220):35–45. Medline, Google Scholar
5. Leach RE, Bolton PE. Arthritis of the carpometacarpal joint of the thumb. Results of arthrodesis. J Bone Joint Surg Am. 1968;50(6):1171–1177. Crossref, Medline, Google Scholar
6. Pardini AG, Lazaroni AP, Tavares KE. Compression arthrodesis of the carpometacarpal joint of the thumb. Hand. 1982;14(3):291–294. https://doi.org/10.1016/s0072-968x(82)80063-6. Crossref, Google Scholar
7. Cavallazzi RM, Spreafico G. Trapezio-metacarpal arthrodesis today: Why? J Hand Surg Br. 1986;11(2):250–254. Crossref, Medline, Google Scholar
8. Carroll RE. Arthrodesis of the carpometacarpal joint of the thumb. A review of patients with a long postoperative period. Clin Orthop. 1987;(220):106–110. Medline, Google Scholar
9. Bamberger HB, Stern PJ, Kiefhaber TR, McDonough JJ, Cantor RM. Trapeziometacarpal joint arthrodesis: A functional evaluation. J Hand Surg Am. 1992;17(4):605–611. https://doi.org/10.1016/0363-5023(92)90302-6. Crossref, Google Scholar
10. Caputo RJ, Bennett JB. Power staple fixation in trapeziometacarpal arthrodesis. J Hand Surg Am. 1993;18(5):926–929. https://doi.org/10.1016/0363-5023(93)90067-D. Crossref, Google Scholar
11. Chamay A, Piaget-Morerod F. Arthrodesis of the trapeziometacarpal joint. J Hand Surg Br. 1994;19(4):489–497. https://doi.org/10.1016/0266-7681(94)90215-1. Crossref, Google Scholar
12. Lisanti M, Rosati M, Spagnolli G, Luppichini G. Trapeziometacarpal joint arthrodesis for osteoarthritis. Results of power staple fixation. J Hand Surg Br. 1997;22(5):576–579. https://doi.org/10.1016/s0266-7681(97)80348-8. Crossref, Google Scholar
13. Ishida O, Ikuta Y. Trapeziometacarpal joint arthrodesis for the treatment of arthrosis. Scand J Plast Reconstr Surg Hand Surg. 2000;34(3):245–248. https://doi.org/10.1080/02844310050159828. Crossref, Google Scholar
14. Damen A, Dijkstra T, van der Lei B, den Dunnen WF, Robinson PH. Long-term results of arthrodesis of the carpometacarpal joint of the thumb. Scand J Plast Reconstr Surg Hand Surg. 2001;35(4):407–413. https://doi.org/10.1080/028443101317149372. Crossref, Google Scholar
15. Fulton DB, Stern PJ. Trapeziometacarpal arthrodesis in primary osteoarthritis: A minimum two-year follow-up study. J Hand Surg Am. 2001;26(1):109–114. https://doi.org/10.1053/jhsu.2001.20964. Crossref, Google Scholar
16. Rizzo M, Moran SL, Shin AY. Long-term outcomes of trapeziometacarpal arthrodesis in the management of trapeziometacarpal arthritis. J Hand Surg Am. 2009;34(1):20–26. https://doi.org/10.1016/j.jhsa.2008.09.022. Crossref, Google Scholar
17. Hayashi M, Uchiyama S, Nakamura K, Itsubo T, Momose T, Kato H. Arthrodesis of carpometacarpal joint of the thumb with plate fixation and bone grafting: A retrospective review. J Orthop Sci. 2015;20(2):302–306. https://doi.org/10.1007/s00776-014-0685-1. Crossref, Google Scholar
18. Tomaino MM, Pellegrini Jr VD, Burton RI. Arthroplasty of the basal joint of the thumb. Long-term follow-up after ligament reconstruction with tendon interposition. J Bone Joint Surg Am. 1995;77(3):346–355. https://doi.org/10.2106/00004623-199503000-00003. Crossref, Google Scholar
19. Mureau MA, Rademaker RP, Verhaar JA, Hovius SE. Tendon interposition arthroplasty versus arthrodesis for the treatment of trapeziometacarpal arthritis: A retrospective comparative follow-up study. J Hand Surg Am. 2001;26(5):869–876. https://doi.org/10.1053/jhsu.2001.26659. Crossref, Google Scholar
20. Vermeulen GM, Brink SM, Slijper H, et al.. Trapeziometacarpal arthrodesis or trapeziectomy with ligament reconstruction in primary trapeziometacarpal osteoarthritis. J Bone Joint Surg Am. 2014;96(9):726–733. https://doi.org/10.2106/JBJS.L.01344. Crossref, Google Scholar
21. Forseth MJ, Stern PJ. Complications of trapeziometacarpal arthrodesis using plate and screw fixation. J Hand Surg Am. 2003;28(2):342–345. https://doi.org/10.1053/jhsu.2003.50042. Crossref, Google Scholar
22. Stokel EA, Tencer AF, Driscoll HL, Trumble TE. A biomechanical comparison of four methods of fixation of the trapeziometacarpal joint. J Hand Surg Am. 1994;19(1):86–92. https://doi.org/10.1016/0363-5023(94)90228-3. Crossref, Google Scholar
23. Eaton RG, Glickel SZ. Trapeziometacarpal osteoarthritis. Staging as a rationale for treatment. Hand Clin. 1987;3(4):455–471. Crossref, Medline, Google Scholar
24. Tang JB, Giddins G. Why and how to report surgeon’s levels of expertise. J Hand Surg Eur. 2016;41(4):365–366. https://doi.org/10.1177/1753193416641590. Crossref, Google Scholar
25. Dormitorio B, Hattori Y, Yukata K, Sakamoto S, Doi K. The use of dynamic radiographs in trapeziometacarpal joint arthrodesis for accurate range of motion evaluation. J Orthop Sci. 2018;23(1):75–80. https://doi.org/10.1016/j.jos.2017.09.022. Crossref, Google Scholar
26. Imaeda T, Toh S, Nakao Y, et al.. Validation of the Japanese Society for Surgery of the Hand version of the Disability of the Arm, Shoulder, and Hand questionnaire. J Orthop Sci. 2005;10(4):353–359. https://doi.org/10.1007/s00776-005-0917-5. Crossref, Google Scholar
27. Hartigan BJ, Stern PJ, Kiefhaber TR. Thumb carpometacarpal osteoarthritis: Arthrodesis compared with ligament reconstruction and tendon interposition. J Bone Joint Surg Am. 2001;83(10):1470–1478. https://doi.org/10.2106/00004623-200110000-00002. Crossref, Google Scholar
28. Crosby EB, Linscheid RL, Dobyns JH. Scaphotrapezial trapezoidal arthrosis. J Hand Surg Am. 1978;3(3):223–234. https://doi.org/10.1016/s0363-5023(78)80086-0. Crossref, Google Scholar
29. Eiken O, Carstam N. Functional assessment of basal joint fusion of the thumb. Scand J Plast Reconstr Surg. 1970;4(2):122–125. https://doi.org/10.3109/02844317009038455. Crossref, Google Scholar
30. Stark HH, Moore JF, Ashworth CR, Boyes JH. Fusion of the first metacarpotrapezial joint for degenerative arthritis. J Bone Joint Surg Am. 1977;59(1):22–26. Crossref, Medline, Google Scholar