Arthroscopic partial trapeziectomy may be effective, safe for carpometacarpal arthritis
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Results showed arthroscopic partial trapeziectomy with thermal shrinkage and K-wire fixation may be an effective and safe procedure for thumb carpometacarpal joint arthritis.
“[This procedure] successfully maintained improvement of functional outcome, preserved the mechanical height of the trapezium, increased the [carpometacarpal] CMC space and decreased metacarpal subluxation without the need for soft tissue interposition and ligament reconstruction,” the authors wrote. “However, a surgeon skilled in arthroscopy should perform the procedure.”
Researchers collected preoperative and postoperative Modified Mayo Wrist Score, DASH score, radiographic changes and associated complications among 24 patients with thumb carpometacarpal joint arthritis who underwent arthroscopic partial trapeziectomy combined with thermal shrinkage and K-wire fixation between February 2013 March 2014.
Overall, 16 patients completed 5 years of functional score and radiographic follow-up, according to researchers. Results showed significant improvements in the Modified Mayo Wrist Score and DASH score from preoperatively to postoperatively. Researchers found significant differences in the carpometacarpal joint distance, scaphoid-metacarpal distance, trapezium-metacarpal distance and metacarpal prominence distance between preoperative and postoperative evaluation of radiographic changes.
Perspective
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This article describes yet another surgical technique for the treatment of thumb carpometacarpal (CMC) osteoarthritis. The technique is an arthroscopic hemi-trapeziectomy with pinning. The authors evaluated 16 patients and found an improvement in both Modified Mayo Wrist and DASH scores at 5 years postoperatively. They took great care in studying several different radiographic parameters and positive findings include maintenance of trapezial height, increased CMC space and decreased metacarpal subluxation.
Like many other published techniques and studies on the surgical treatment of thumb CMC OA, this technique appears to be effective, although the size of the study group is small. Since it is arthroscopic, it can be called “minimally” invasive, although I would argue that it is not that much less invasive than an open hemi-trapeziectomy and pinning. I would be interested in knowing the time it took for the authors to perform this procedure, particularly if there is a large medial spur which they admit could be difficult and time-consuming to remove arthroscopically. To conclude, the authors should be commended for reporting 5-year follow-up data on their technique, but this study will not change how I treat my patients with thumb CMC OA.
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