How does Fixation Alignment Affect Surgical Outcomes in Arthrodesis for Thumb Carpometacarpal Osteoarthritis?

Abstract

Purpose Arthrodesis is a traditional surgical procedure for treating thumb carpometacarpal (CMC) osteoarthritis. Previous studies have investigated surgical outcomes, focusing on the fixation technique, bone union rate, and surgical complications but not on the postoperative alignment of the thumb CMC joints. Therefore, we aimed to investigate how thumb fixation alignment affects the surgical outcomes of thumb CMC arthrodesis.

Patients and Methods Twenty-six patients (28 thumbs) who achieved bone union after arthrodesis with more than 1-year follow-up were retrospectively analyzed. We measured the radial abduction and palmar abduction angles and change in thumb length (Δthumb length) on postoperative radiographs and the first metacarpal rotation angle on postoperative computed tomography. Moreover, we investigated the 1-year clinical outcomes, including the Disabilities of Arm, Shoulder, and Hand (DASH) score, Hand20 questionnaire score, visual analog scale (VAS) score for pain, Δgrip strength, Δpulp pinch, and Δkey pinch strength. The correlation between the postoperative alignment and clinical outcomes was also statistically analyzed.

Results The mean radial abduction, palmar abduction, first metacarpal rotation angles, and Δthumb length were 20.8 degrees, 34.4 degrees, 109.4 degrees, and −1.8 mm, respectively. Radial abduction and palmar abduction angles were positively and negatively correlated with Δgrip strength (r = 0.37 and −0.37), respectively. The first metacarpal rotation angle was positively correlated with the DASH score (r = 0.51), Hand20 score (r = 0.48), and VAS score for pain (r = 0.42). ΔThumb length had no correlation with clinical outcomes at 1-year follow-up.

Conclusion Thumb fixation alignment has an impact on the surgical outcomes of thumb CMC arthrodesis. To obtain a successful outcome, it is important to add slight pronation and avoid excessively small radial abduction and excessively large palmar abduction.

Keywords

thumb carpometacarpal osteoarthritis - arthrodesis - alignment - surgical outcomes

Ethical Considerations

This retrospective study was approved by the institutional review board of Gifu University Graduate School of Medicine (2018–217).

Authors' Contributions

S.K. designed the study. S.K., A.H., H.H., and A.K. performed the operation. S.K., Y.I., A.K., and H.A. analyzed the data and wrote the manuscript.

Ethical Approval

This retrospective study was approved by our institutional review board.

Informed Consent

Informed consent was obtained from all patients included in the study.

Publikationsverlauf

Eingereicht: 21. März 2024

Angenommen: 21. Mai 2024

Artikel online veröffentlicht:
05. Juli 2024

• References

• 1 Davis TR, Brady O, Dias JJ. Excision of the trapezium for osteoarthritis of the trapeziometacarpal joint: a study of the benefit of ligament reconstruction or tendon interposition. J Hand Surg Am 2004; 29 (06) 1069-1077
• 2 Komura S, Hirakawa A, Masuda T. et al. Chronological changes in surgical outcomes after trapeziectomy with ligament reconstruction and tendon interposition arthroplasty for thumb carpometacarpal osteoarthritis. Orthop Traumatol Surg Res 2020; 106 (02) 357-364
• 3 Degeorge B, Dagneaux L, Andrin J, Lazerges C, Coulet B, Chammas M. Do trapeziometacarpal prosthesis provide better metacarpophalangeal stability than trapeziectomy and ligamentoplasty?. Orthop Traumatol Surg Res 2018; 104 (07) 1095-1100
• 4 London DA, Stern PJ. Carpometacarpal arthrodesis: indications and techniques. Hand Clin 2022; 38 (02) 231-240
• 5 Nüesch C, Schweizer A, Weber A, Reissner L. Basal osteotomy of the first metacarpal using patient-specific guides and instrumentation: biomechanical and 3D CT-based analysis. Arch Orthop Trauma Surg 2024; 144 (01) 551-558
• 6 Komura S, Hirakawa A, Masuda T. et al. Does trapeziectomy with ligament reconstruction and tendon interposition arthroplasty correct the metacarpophalangeal joint hyperextension associated with trapeziometacarpal osteoarthritis?. Arch Orthop Trauma Surg 2021; 141 (07) 1261-1268
• 7 Tomaino MM. Basal metacarpal osteotomy for osteoarthritis of the thumb. J Hand Surg Am 2011; 36 (06) 1076-1079
• 8 Komura S, Hirakawa A, Hirose H, Akiyama H. Trapeziectomy with ligament reconstruction and tendon interposition arthroplasty continuously improves hand functions up to 5-year postoperatively. Arch Orthop Trauma Surg 2023; 143 (07) 4539-4546
• 9 Yao J, Zlotolow DA, Murdock R, Christian M. Suture button compared with K-wire fixation for maintenance of posttrapeziectomy space height in a cadaver model of lateral pinch. J Hand Surg Am 2010; 35 (12) 2061-2065
• 10 Weiss AC, Kamal RN, Paci GM, Weiss BA, Shah KN. Suture suspension arthroplasty for the treatment of thumb carpometacarpal arthritis. J Hand Surg Am 2019; 44 (04) 296-303
• 11 Deutch Z, Niedermeier SR, Awan HM. Surgeon preference, influence, and treatment of thumb carpometacarpal arthritis. Hand (N Y) 2018; 13 (04) 403-411
• 12 Yin Q, Berkhout MJL, Ritt MJPF. Current trends in operative treatment of carpometacarpal osteoarthritis: a survey of European hand surgeons. Eur J Plast Surg 2019; 42: 365-368
• 13 Yuan F, Aliu O, Chung KC, Mahmoudi E. Evidence-based practice in the surgical treatment of thumb carpometacarpal joint arthritis. J Hand Surg Am 2017; 42 (02) 104-112.e1
• 14 Komura S, Hirakawa A, Hirose H, Akiyama H. Minimally invasive arthroscopy-assisted arthrodesis for thumb carpometacarpal osteoarthritis. Arch Orthop Trauma Surg 2024; 144 (02) 967-974
• 15 Leach RE, Bolton PE. Arthritis of the carpometacarpal joint of the thumb. Results of arthrodesis. J Bone Joint Surg Am 1968; 50 (06) 1171-1177
• 16 van Laarhoven CMCA, Schrier VJMM, van Heijl M, Schuurman AH. Arthrodesis of the carpometacarpal thumb joint for osteoarthritis; long-term results using patient-reported outcome measurements. J Wrist Surg 2019; 8 (06) 489-496
• 17 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
• 18 Kazmers NH, Hippensteel KJ, Calfee RP. et al. Locking plate arthrodesis compares favorably with LRTI for thumb trapeziometacarpal arthrosis: early outcomes from a longitudinal cohort study. HSS J 2017; 13 (01) 54-60
• 19 Hattori Y, Hayashi K, Chia DSY, Sakamoto S, Doi K. Arthrodesis for primary osteoarthritis of trapeziometacarpal joint using multiple Kirschner wires and tension band wire in female patients older than 40. J Hand Surg Asian Pac Vol 2022; 27 (03) 524-533
• 20 Forseth MJ, Stern PJ. Complications of trapeziometacarpal arthrodesis using plate and screw fixation. J Hand Surg Am 2003; 28 (02) 342-345
• 21 Fulton DB, Stern PJ. Trapeziometacarpal arthrodesis in primary osteoarthritis: a minimum two-year follow-up study. J Hand Surg Am 2001; 26 (01) 109-114
• 22 Jiménez-Díaz V, Cecilia-López D, Porras-Moreno MÁ, Muñoz-Sánchez G, García-Lamas L, Jara-Sánchez F. Arthrodesis of the thumb carpometacarpal joint using a quadrangular plate: surgical technique and long-term results of 70 patients. Eur J Orthop Surg Traumatol 2017; 27 (07) 909-915
• 23 Galán A, Arenas JR, del Águila B, Guerado E, Andrés-Cano P. Trapezio-metacarpal arthrodesis: procedure and results. Eur J Orthop Surg Traumatol 2015; 25 (03) 483-488
• 24 Li J, Li D, Tian G, Zhang W. Comparison of arthrodesis and arthroplasty of Chinese thumb carpometacarpal osteoarthritis. J Orthop Surg Res 2019; 14 (01) 404
• 25 Hayashi M, Uchiyama S, Nakamura K, Itsubo T, Momose T, Kato H. Arthrodesis of the carpometacarpal joint of the thumb with plate fixation and bone grafting: a retrospective review. J Orthop Sci 2015; 20 (02) 302-306
• 26 Muramatsu K, Tominaga Y, Hashimoto T, Taguchi T. Cross-shaped bone grafting and locking plate fixation for arthrodesis of the trapeziometacarpal joint: surgical technique and early mobilization. J Hand Surg Asian Pac Vol 2019; 24 (01) 55-59
• 27 Save AV, Wolfe SW, Victoria C, Osei DA. Trapeziometacarpal joint arthrodesis using a cannulated compression screw and locking plate construct. HSS J 2022; 18 (04) 559-565
• 28 Cha SM, Shin HD, Kim KC, Park JW. Comparison of grip strength among 6 grip methods. J Hand Surg Am 2014; 39 (11) 2277-2284
• 29 Goubier JN, Devun L, Mitton D, Lavaste F, Papadogeorgou E. Normal range-of-motion of trapeziometacarpal joint. Chir Main 2009; 28 (05) 297-300
• 30 Crisco JJ, Halilaj E, Moore DC, Patel T, Weiss AP, Ladd AL. In Vivo kinematics of the trapeziometacarpal joint during thumb extension-flexion and abduction-adduction. J Hand Surg Am 2015; 40 (02) 289-296
• 31 D'Agostino P, Dourthe B, Kerkhof F, Stockmans F, Vereecke EE. In vivo kinematics of the thumb during flexion and adduction motion: Evidence for a screw-home mechanism. J Orthop Res 2017; 35 (07) 1556-1564
• 32 Richards T, Newington D. The results of carpometacarpal joint arthrodesis of the osteoarthritic thumb in younger patients using memory staples. J Hand Microsurg 2020; 14 (03) 266-267
• 33 Schröder J, Kerkhoffs GM, Voerman HJ, Marti RK. Surgical treatment of basal joint disease of the thumb: comparison between resection-interposition arthroplasty and trapezio-metacarpal arthrodesis. Arch Orthop Trauma Surg 2002; 122 (01) 35-38
• 34 Molin U, Evans K, Wilcke M. Does proximal migration of the first metacarpal correlate with remaining pain after trapeziectomy?. J Plast Surg Hand Surg 2022; 56 (01) 11-15
• 35 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 (01) 75-80