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This prospective study compared the outcome — subjective, objective and radiographic — of two surgical techniques for treating basal joint arthritis of the thumb: a "simple" trapeziectomy (group I) and a ligament reconstruction/tendon (group II) interposition technique. There were respectively 22 patients in group I and 34 in group II, all women with primary osteoarthritis.

Both techniques gave favourable results and there were no significant differences for pain relief, patient satisfaction, mobility, DASH-score, key pinch force and gripping force. However in group II, the trapezial height was better preserved indicating that the proximal migration of the thumb was prevented or limited. There was also a significant correlation between the remaining trapezial space and key pinch force.

We performed a retrospective review of 22 thumbs in 22 Chinese patients attending for the basal joint arthritis of the thumb over the last 14 years. There were 16 women and six men with a mean age of 50 years old. All were treated surgically by partial trapeziectomy and volar oblique ligament reconstruction with flexor carpi radialis tendon and interpositional arthroplasty with a free palmaris longus tendon ball after failure of conservative treatment. The mean follow-up time was 48 months. Radiographs did not show any differences in the arthroplasty space index, arthroplasty space, trapezial space ratio and scaphoid-thumb metacarpal distance at the pre-operative evaluation and at the final follow-up evaluation. There was significant difference in the pain score, grip strength, Kapandji score and functional status before and after surgery at final follow-up period. One patient had complex regional pain syndrome which was resolved after receiving a course of anti-inflammatory drugs and physiotherapy. The authors suggest that the modified technique of partial trapeziectomy with tendon interpositional arthroplasty is a safe and effective method in treating basal joint arthritis of the thumb with good short term functional and radiological outcomes and minimal complication.

Purpose: To identify the wrist tendon most effectively maintaining the trapezial space in interpositional arthroplasty in osteoarthritis of the carpometacarpal joint of the thumb.

Methods: The morphometrics of the os trapezium and the tendons of the flexor carpi radialis, extensor carpi radialis longus, and abductor pollicis longus were determined. The stiffness and compressive loading characteristics of the rolled-up tendons were compared to the os trapezium.

Results: No significant morphometric differences between the three tendons were found. The mass and volume of the trapezium was significantly larger when compared to the tendon balls. No significant differences in the compressive loading resistance were found between the tendons, but the mean stiffness was 85% lower when compared to the os trapezium.

Conclusions: Neither tendon material approached the volume nor the stiffness provided by the os trapezium. Any tendon is considered to insufficiently maintain the trapezial space following trapeziectomy.

Purpose: To investigate the long-term (> 10 yrs) outcomes of trapeziectomy with ligament reconstruction and tendon interposition (LRTI).

Methods: We reviewed 15 cases of trapeziectomy with LRTI performed for the treatment trapeziometacarpal osteoarthritis. Mean follow up was 13.5 yrs (range, 10.5–17.5 yrs). We assessed a number of subjective and objective outcomes. A good outcome was a participant who did not require revision surgery, was satisfied with the outcome of their surgery and did not experience rest pain.

Results: No patients had revision surgery and only two patients were unsatisfied or very unsatisfied with the outcome of their surgery. Pain with activity was the strongest predictor of participant satisfaction.

Discussion: Approximately half the participants in this study experienced good long-term outcomes. Some participants were experiencing long-term symptoms, particularly pain, despite reporting that they are satisfied with the outcome of their surgery. Alternative techniques should be investigated that provide superior long-term outcomes.

Trapeziectomy and Weilby ligament reconstruction is a recognized treatment for osteoarthritis of the trapeziometacarpal joint. Studies published using this procedure have limited follow-up post-surgery. In this series of 24 cases assessed objectively and 36 subjectively with a minimum follow-up of five years, patients continue to have pain relief and function comparable to the opposite non-operated hand. Patient satisfaction is high at 92% and the rate of complications is low. Despite these encouraging results the need for interposition arthroplasty and/or ligament reconstruction in addition to trapeziectomy alone is discussed.

Thumb carpometacarpal joint (CMCJ) osteoarthritis is a common complaint that produces pain and disability within the hand. This study aims to ascertain whether joint injection with local anaesthetic and steroid is of predicative value in disease progression in thumb carpometacarpal osteoarthritis.

Forty-three patients were assessed at an average follow up of 24 months following ultrasound-guided injection. Fourteen patients (32%) progressed to surgery, at a mean interval of 8.6 months (range 4–14 months).

There was a statistically significant correlation between those patients who had on-going pain following injection at one week and progression to surgery (p = 0.025) with an odds ratio of 3.14 and positive likelihood ratio of 2.1.

Patients with thumb CMCJ osteoarthritis that does not respond favourably to injection at one week are likely to progress to surgery in the first year after the injection. This work offers a useful tool in predicting disease progression and patient counseling.

Background: The management of scaphotrapeziotrapezoidal (STT) joint osteoarthritis (OA) remains controversial. This systematic review aims to review the evidence for surgical interventions specific to STT OA.

Methods: Medline and Embase libraries were searched using a pre-defined search strategy in October 2014. All study designs and languages were included and evaluated by two reviewers (VMD and LM) against the inclusion/exclusion criteria. The study eligibility criteria included papers discussing surgical treatment of STT OA, and the review was conducted using the PRISMA guidelines.

Results: 295 unique results were identified from the search strategy after duplicates were filtered. 21 articles met the eligibility criteria.

Conclusions: Trapezial excision and partial trapezoidal excision is an effective treatment with low morbidity and complications, although can lead to weakness of the thumb. Distal scaphoid excision remains an effective pain relief treatment with improved grip and pinch strengths post-operatively. The procedure is technically less demanding than arthrodesis, does not carry the risks of non-union and complication rate of STT joint arthrodesis, and has a shorter immobilisation requirement. It produces reliable results, but is contraindicated if there is either scapholunocapitate pathology or midcarpal instability. STT joint fusion has a place, typically producing 75% range of movement of the non-operated wrist. However it has a higher associated complication rate, and simultaneous radial styloidectomy is recommended to reduce ongoing pain from impingement. Implant arthroplasty using a graphite-coated pyrocarbon implant has been used more recently. The patients gained significant pain relief, although there have been reports of implant dislocation secondary to surgical errors. A reduction in post-operative wrist extension and radial deviation has been noted. From this systematic review, we have composed a treatment algorithm for the surgical management of STT joint OA.

Background: Thumb carpometacarpal joint arthroplasty for osteoarthritis may hold advantages over trapeziectomy by preserving range of motion, whilst providing stability and preventing thumb shortening.

Methods: We compare functional and satisfaction outcomes scores, radiological shortening and complication rates between patients treated with trapeziectomy and those receiving the ARPE thumb CMCJ arthroplasty.

Results: Seventy-five trapeziectomies and one hundred and ten ARPE arthroplasties were performed over the study period. Both treatments resulted in significant improvements in functional scores. When matching patients according to pre-operative function, patients receiving the ARPE arthroplasty had better post-operative function (Quick DASH: trapeziectomy = 25.1, ARPE = 16.8). More patients receiving the ARPE arthroplasty were satisfied with their treatment (trapeziectomy = 7.8/10, ARPE = 8.7/10) and would have the same treatment again (trapeziectomy = 76%, ARPE = 89%). The ARPE also resulted in less thumb shortening. However the ARPE arthroplasty is associated with a higher complication rate, with 14% of patients requiring further surgery at a mean of 2 years follow up (95% implant survival).

Conclusions: Both trapeziectomy and the ARPE CMCJ arthroplasty are effective treatment options for thumb CMCJ osteoarthritis. Arthroplasty may offer potential advantages in terms of post-operative function and patient satisfaction. However the risk of complications and requirement for further surgery is greater and must be carefully considered during patient selection and pre-operative counselling.

Background: Various surgical techniques were reported with excellent result for the treatment of trapeziometacarpal joint arthritis. However, the best treatment option was not defined yet.

Methods: This randomized prospective study compared the result of two surgical techniques: tendon interposition arthroplasty (64 patients) and K. wire distraction (56 patients) after trapeziectomy for stage 3 or 4 osteoarthritis of the trapeziometacarpal joint.

Results: After a mean follow-up period of 6.8 (range, 3-10) years it was possible to observe a higher rate of pain relief following trapeziectomy with K. wire suspension, but no significant differences in strength, range of motion and DASH score between the two groups. On lateral unloaded radiographs the height of the space between the base of the thumb metacarpal and the scaphoid showed a mean value of 6.5 mm for both groups; the average distance between the metacarpal base and the trapezium was not statistically significant in the two groups. Complications were observed only in patients treated with trapeziectomy and interposition arthroplasty and were represented by tendinitis of the FCR in 15% of cases.

Conclusions: We demonstrate that the trapezium excision and bone space distraction technique requires a smaller incision, a shorter surgical time, an easier surgical technique, and a less painful recovery, maintaining overlapping levels of functional restore.

Background: Patients with advanced osteoarthritis of the first carpometacarpal joint (CMC-1) may develop hyperextension of the first metacarpophalangeal joint (MCP-1). No clear clinical benefice has been reported consecutively to the surgical treatment of the MCP-hyperextension combined to a trapeziectomy. The reason of the missing benefit may be due to changes in the thumb position impairing the thumb stability secondary to the surgical procedures. We assessed changes in the transmission of forces at the thumb’s end phalanx following a trapeziectomy combined with the surgical adjustment of the hyperextension of the MCP-1-joint in a biomechanical investigation using cadavers.

Methods: The thumb muscles were loaded with nylon cables connected to a tension meter in 8 forearm cadavers. A 6-axis force sensor assessed the termino-lateral key-pinch orthogonal strength vectors at the level of the thumb distal phalanx prior to any surgery, and following a simple trapeziectomy, a trapeziectomy combined to a MCP-1-capsulodesis and the transfer of the extensor pollicis brevis over the metacarpal-1 head, or to an MCP-1-arthrodesis.

Results: Combination of the trapeziectomy with the MCP-1- joint palmar capsulodesis and EPB-transfer or with a MCP-arthrodesis in neutral pronation-supination resulted in a significant shift of the thumb in pronation-abduction with respect to the preoperative assessment. The lowest shift was achieved when performing the arthrodesis in 20° supination or by overloading of the adductor pollicis.

Conclusions: Combining the trapeziectomy with surgeries addressing the MCP-1-joint hyperextension induced a shift of the thumb in pronation-abduction that could impair the key-pinch stability. When considering additional procedures for MCP-1-joint hyperextension deformities, it should be recommended to fix the EPB-tendon on the radial aspect of the metacarpal head if a tendon transfer is considered, otherwise the MCP joint arthrodesis should be performed in supinated position, in order to achieve lateral key-pinch stability.

Background: The purpose of this retrospective study was to report and compare the outcomes of the MAIA^® prosthesis and trapeziectomy for trapeziometacarpal osteoarthritis.

Methods: We included 92 consecutive patients (8 men, 84 women) with a mean age of 57 years (range 44–75 years) who underwent trapeziectomy (44 patients) or trapeziometacarpal joint replacement with a MAIA^® prosthesis (48 patients) for painful osteoarthritis. All patients were evaluated (pain, range of motion, strength, function, X-rays) by an independent examiner.

Results: The two groups of patients had comparable preoperative characteristics. At the mean follow-up of 9 years (range: 8–10), we found a significant reduction in pain levels for each group. In the final data review, there were no significant differences in terms of pain levels, grip strength, thumb active motion and the Quick Disabilities of the Arm, Shoulder and Hand score between the two groups. Pinch strength and the work performance score on the Michigan Hand Questionnaire were significantly better in the MAIA^® prosthesis group. The MAIA^® group had a shorter postoperative recovery time of 6 weeks and fewer patients required physiotherapy. Postoperatively, the thumb column length was significantly less in the trapeziectomy group. In this group, we found a significant decrease in the trapezial cavity height between the immediate postoperative evaluation and the final assessment, with three patients having painful scaphometacarpal impingement. Two patients required surgical revision for symptomatic meta-carpophalangeal joint hyperextension. In the MAIA^® group, we found no implant subsidence, loosening, dislocation or fracture. None of the implants were revised.

Conclusions: From this study, we found that the both procedures can be used as a surgical treatment for trapeziometacarpal osteoarthritis. The MAIA^® prosthesis is a useful alternative to trapeziectomy and appears to be a reliable and effective implant in the medium- to long-term.

Background: Osteoarthritis of the thumb base is the second most prevalent arthritis of the hand. Management is primarily conservative, consisting of analgesia, splinting, physiotherapy, and steroid injections. Surgery is considered when conservative measures fail.

Methods: The primary objective was to assess the safety and efficacy of the surgical interventions and therein, evaluate whether any superiority exists among the available interventions. Efficacy was evaluated by examining four parameters: pain, function, range of movement and strength of the joint postoperatively. Safety was determined by comparing the rate and severity of postoperative complications. A systematic search of MEDLINE (2014–2019), EMBASE (2014–2019), CINAHL (2014–2019) and CENTRAL (2014–2019) databases was carried out. Abstracts were screened for relevant studies. Randomised controlled trials were only considered.

Results: Eight studies were included in the quantitative synthesis. The procedures evaluated are: Trapeziectomy (T), trapeziectomy with ligament reconstruction (T + LR), trapeziectomy with ligament reconstruction and tendon interposition (T + LRTI), trapeziectomy with allograft suspension (T + ALS) and joint arthrodesis (A). Low-moderate quality evidence suggests that T + LRTI yields better range of movement (palmar abduction) when compared with (T) alone; (SMD 0.61, 95% CI 0.22 to 1.00, random-effects, p = 0.002). Comparing adverse events showed that arthrodesis carries a greater risk of adverse events when compared with T + LRTI; (RR 0.33, 95% CI 0.17 to 0.61, random-effects, p = 0.0005). In addition, T + LRTI is preferred over arthrodesis by patients (OR 0.29 95% CI 0.09 to 0.95; p = 0.04). This difference was no seen in the other comparison groups.

Conclusions: It is difficult to declare with any degree of certainty which procedure offers the best functional outcome and safety profile. Results suggest T + LRTI yields good postoperative range of movement. Arthrodesis demonstrated an unacceptably high rate of moderate-severe complications and should be considered with careful consideration.

Background: The outcomes of trapeziectomy with ligament reconstruction and tendon interposition (LRTI) compared to the trapeziectomy (T) alone or in combination with tendon interposition (TIA) in the treatment of osteoarthritis (OA) of the carpometacarpal joint (CMCJ) of the thumb are still debated. The aim of this study is to conduct a meta-analysis to determine whether the outcomes of LRTI were better compared to T or TIA.

Methods: A meta-analysis of randomised trials that included the outcomes of patients with thumb CMCJ OA that underwent LRTI, T or TIA with at least 1 year follow-up. The outcomes included number of patients with pain 1 year after surgery (NPP), Visual Analog Scale for Pain (VAS Pain), key pinch strength, patient reported outcome measurements (PROMs) and number of adverse effect (AEs). The effect was assessed using mean difference for quantitative variables (VAS pain and key pinch), standardised mean difference for PROMs and relative risk for binary variables (NPP and AEs).

Results: Seven studies met the inclusion criteria (857 participants: 438 LRTI vs 419 T/TIA). We did not find significant differences between LRTI and T/TIA in NPP, VAS pain, key pinch at 1 year and 5 years or more, PROMs, and AEs at 1 year and at 5 years or more after surgery.

Conclusions: The outcomes of LRTI are not superior to T or TIA in the treatment of OA of the thumb CMCJ.

Level of Evidence: Level I (Therapeutic)

Background: This retrospective study compares the outcomes of trapeziectomy and Weilby suspensionplasty procedure versus implant arthroplasty using the TOUCH^® prosthesis for basilar thumb arthritis in an Asian population.

Methods: A total of 15 consecutive thumbs in 13 patients were included in this study. Six patients (2 male, 4 female, mean age of 62 years old) underwent trapeziectomy and Weilby suspensionplasty procedure. Seven patients (4 male, 3 female, mean age 63 years old) underwent implant CMCJ arthroplasty using the TOUCH^® prosthesis. Data collected include demographics, severity of arthritis on plain radiographs of the thumb basilar joint, length of follow-up, pre- and postoperative pain levels, Kapandji thumb opposition score, grip and pinch strength and the time taken to return to work.

Results: Patients in the trapeziectomy and Weilby suspensionplasty group had a mean follow-up of 4.5 months, while those in the TOUCH^® implant arthroplasty group had a mean follow-up of 14 months. TOUCH^® implant arthroplasty patients showed significantly higher grip strengths at 3 months post-surgery and a shorter return to work. There were no differences in pinch strength at 3 months, pinch or grip strength at 6 months or pain scores. Complications included prolonged scar hypersensitivity in two patients who underwent the Weilby suspensionplasty and a dislocated TOUCH^® implant cup in one patient.

Conclusions: Our study suggests that in the short term, CMCJ implant arthroplasty with the TOUCH^® prosthesis produces results comparable to trapeziectomy and Weilby suspensionplasty.

Level of Evidence: Level III (Therapeutic)