Background: There has been considerable controversy
regarding the procedure of choice for treatment of any given stage
of osteoarthritis of the thumb carpometacarpal joint. This study
was designed to directly compare the clinical results of two common
surgical procedures for this condition, trapeziometacarpal arthrodesis
and trapezial excision with ligament reconstruction and tendon interposition,
in similar patient populations.
Methods: Between 1988 and 1998, 109 patients (141
thumbs) who were less than sixty years old were treated with one
of the two procedures. In a retrospective review, forty-two
patients (fifty-eight thumbs) treated with arthrodesis
completed an outcome questionnaire and twenty-nine patients
(forty-four thumbs) treated with arthrodesis completed
the questionnaire and were examined. In the group treated with trapezial
excision with ligament reconstruction and tendon interposition, thirty-nine
patients (forty-nine thumbs) completed the questionnaire
and thirty patients (thirty-eight thumbs) completed the
questionnaire and were examined. The average duration of follow-up
was sixty-nine months. The groups were similar with regard
to age, gender, hand dominance, and duration of follow-up.
Results: Subjective evaluation of pain, function,
and satisfaction demonstrated no significant difference between
the two groups, with >90% of patients satisfied
following either procedure. Although grip strength did not differ
between the groups, the arthrodesis group had significantly stronger
lateral pinch (p < 0.001) and chuck pinch (p < 0.01).
The group treated with ligament reconstruction and tendon interposition
had a better range of motion with regard to opposition (p < 0.05)
and the ability to flatten the hand (p < 0.0001). There
was a higher complication rate in the arthrodesis group, with nonunion
of the fusion site accounting for the majority of the complications.
However, despite a persistent nonunion in six thumbs, those thumbs
and the thumbs in which union was obtained did not differ with regard
to pain; all of the patients with nonunion had improvement in their
pain status compared with preoperatively, and all were very satisfied
with the outcome. Peritrapezial arthritis developed in nine patients
(fourteen thumbs). This finding was not related to age and did not
affect overall pain, function, or satisfaction.
Conclusions: Although traditionally arthrodesis
and ligament reconstruction and tendon interposition have been indicated
in two different patient populations, we compared them in a homogeneous
group and found that the two procedures had similar results with
regard to pain, function, and satisfaction despite minimal differences
in strength and motion. Although complications were more frequent
following arthrodesis, most did not affect the overall outcome.