Surgical Rhizarthrosis Treatment: Trapezius Resection Arthroplasty Associated with Tendon Interposition versus the Kuhns Technique

Abstract

Objective This study aimed to evaluate and compare the clinical and functional outcomes of two surgical procedures performed in patients with severe grade III and IV rhizarthrosis.

Methods We evaluated 39 patients who underwent two surgical techniques for rhizarthrosis treatment: trapeziectomy using the Kuhns technique or tendon interposition, with a minimum follow-up period of 6 months. The primary outcome assessment used the specific Trapeziometacarpal Arthrosis Symptoms and Disability (TASD) questionnaire, and the secondary outcome evaluation employed the shortened version of the Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire and the visual analog scale (VAS).

Results There was no statistically significant difference between groups in the TASD, QuickDASH, and VAS results, and both techniques demonstrated good functional and pain outcomes. No complication required a new surgical approach. We found a positive correlation between TASD and QuickDASH questionnaire scores, suggesting their effectiveness in assessing functionality and disability in subjects with rhizarthrosis.

Conclusion Trapeziectomy using the Kuhns technique and tendon interposition proved effective in the surgical treatment of rhizarthrosis. There was no significant difference between the techniques concerning functional outcomes.

Keywords

orthopedic procedures - osteoarthritis - trapezium bone

Work carried out at the Hospital Alvorada, São Paulo, SP, Brazil.

Publication History

Received: 23 October 2023

Accepted: 05 April 2024

Article published online:
04 September 2024

• Referências

• 1 Armstrong AL, Hunter JB, Davis TR. The prevalence of degenerative arthritis of the base of the thumb in post-menopausal women. J Hand Surg [Br] 1994; 19 (03) 340-341
• 2 Bertozzi L, Valdes K, Vanti C, Negrini S, Pillastrini P, Villafañe JH. Investigation of the effect of conservative interventions in thumb carpometacarpal osteoarthritis: systematic review and meta-analysis. Disabil Rehabil 2015; 37 (22) 2025-2043
• 3 Gervis WH. Excision of the trapezium for osteoarthritis of the trapezio-metacarpal joint. J Bone Joint Surg Br 1949; 31B [phone] , illust
• 4 Conolly WB, Lanzetta M. Surgical management of arthritis of the carpo-metacarpal joint of the thumb. Aust N Z J Surg 1993; 63 (08) 596-603
• 5 Dell PC, Muniz RB. Interposition arthroplasty of the trapeziometacarpal joint for osteoarthritis. Clin Orthop Relat Res 1987; (220) 27-34
• 6 Burton RI, Pellegrini Jr VD. Surgical management of basal joint arthritis of the thumb. Part II. Ligament reconstruction with tendon interposition arthroplasty. J Hand Surg Am 1986; 11 (03) 324-332
• 7 Pellegrini Jr VD, Burton RI. Surgical management of basal joint arthritis of the thumb. Part I. Long-term results of silicone implant arthroplasty. J Hand Surg Am 1986; 11 (03) 309-324
• 8 Kuhns CA, Meals RA. Hematoma and distraction arthroplasty for basal thumb osteoarthritis. Tech Hand Up Extrem Surg 2004; 8 (01) 2-6
• 9 Eaton RG, Glickel SZ. Trapeziometacarpal osteoarthritis. Staging as a rationale for treatment. Hand Clin 1987; 3 (04) 455-471
• 10 Becker SJ, Teunis T, Ring D, Vranceanu AM. The Trapeziometacarpal Arthrosis Symptoms and Disability Questionnaire: Development and Preliminary Validation. Hand (N Y) 2016; 11 (02) 197-205
• 11 Beaton DE, Wright JG, Katz JN. Upper Extremity Collaborative Group. Development of the QuickDASH: comparison of three item-reduction approaches. J Bone Joint Surg Am 2005; 87 (05) 1038-1046
• 12 Huskisson EC. Measurement of pain. Lancet 1974; 2 (7889) 1127-1131
• 13 de Souza Almeida VA, Fernandes CH, Meireles LM, Faloppa F, Ejnisman B, Cohen M. Translation and cross-cultural adaptation of “Trapeziometacarpal Arthrosis Symptoms and Disability-TASD” into Brazilian Portuguese. Adv Rheumatol 2021; 61 (01) 61
• 14 Kuhns CA, Emerson ET, Meals RA. Hematoma and distraction arthroplasty for thumb basal joint osteoarthritis: a prospective, single-surgeon study including outcomes measures. J Hand Surg Am 2003; 28 (03) 381-389
• 15 Berkhout MJ, Bachour Y, Wessing D, Ritt MJPF. Distal Pole Resection of the Scaphoid for the Treatment of Scaphotrapeziotrapezoid Osteoarthritis. Hand (N Y) 2019; 14 (02) 230-235
• 16 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
• 17 Jain A, Herrera FA. Cost Analysis and National Trends in the Treatment of Thumb Basal Arthritis: Comparing Ligament Reconstruction/Tendon Interposition and Trapeziectomy/Hematoma Distraction Arthroplasty. Ann Plast Surg 2021; 86 (6S, Suppl 5) S622-S624
• 18 Tolo ET. Ligament reconstruction and tendon interposition versus trapeziectomy and hematoma distraction arthroplasty for treatment of trapeziometacarpal arthritis. Curr Opin Orthop 2006; 17: 283-287
• 19 Sandvall BK, Cameron TE, Netscher DT, Epstein MJ, Staines KG, Petersen NJ. Basal joint osteoarthritis of the thumb: ligament reconstruction and tendon interposition versus hematoma distraction arthroplasty. J Hand Surg Am 2010; 35 (12) 1968-1975
• 20 Wajon A, Vinycomb T, Carr E, Edmunds I, Ada L. Surgery for thumb (trapeziometacarpal joint) osteoarthritis. Cochrane Database Syst Rev 2015; 2015 (02) CD004631
• 21 Ratneswaran A, Rockel JS, Antflek D. et al. Investigating Molecular Signatures Underlying Trapeziometacarpal Osteoarthritis Through the Evaluation of Systemic Cytokine Expression. Front Immunol 2022; 12: 794792