Distraction Arthroplasty of the Trapeziometacarpal Joint Without Trapeziectomy

Abstract

Thumb carpometacarpal joint (CMC) arthrosis leads to pain and joint instability. Therefore, pain relief and functional restoration of the CMC joint are primary goals of surgical treatment, after failure of conservative treatment. Several options for surgical treatment were listed, ranging from simple debridement of the joint, reconstruction with tendon graft, arthroplasty, to arthrodesis. Distraction arthroplasty is a good choice for mild to moderate CMC arthrosis or instability. Methods: Ten patients with persistent basal joint pain who failed conservative treatment and having basal joint instability with significant poterolateral translation were included. They were treated by distraction arthroplasty without trapeziectomy. The functional outcome was evaluated by Patient-Rated Wrist Evaluation (PRWE) questionnaire. The Wilcoxon signed-rank test was used for analysis. Results: The mean follow up period is 37 months (minimum 15 months). All patients achieved total or near total pain relief. Significant improvement of functional outcome was gained. The PRWE functional score showed an average improvement of 41.5 (p = 0.005). No loss of reduction or CMC joint instability was noted. Conclusion: Our technique (distraction arthroplasty without trapeziectomy) preserves bony and adjacent structures. It is easier and quicker than traditional arthroplasties. It serves as another effective and stable method of tendon reconstruction with a less invasive approach. A larger series is needed for further observation of validity of the procedure.

Keywords

• basal joint subluxation
• carpometacarpal subluxation
• distraction arthroplasty
• trapeziectomy