Short-Term Results after Total Trapeziectomy with a Poly-L/D-Lactide SpacerFunding None.
14 December 2017
21 May 2018
02 July 2018 (online)
Background Proximal migration of the first metacarpal can be seen after total trapeziectomy and various techniques have been described to prevent this subsidence.
Purpose We hypothesized the insertion of a poly-L/D-lactide spacer to prevent proximal migration of the first metacarpal without the need of an additional ligament reconstruction, allowing early mobilization and less demanding rehabilitation.
Patients and Methods Ten thumbs were treated with a total trapeziectomy and insertion of a poly-L/D-lactide scaffold. Clinical and radiological evaluation was performed after 6 months and 1 year. Patient satisfaction, pain, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, mobility of the thumb, and strength were assessed.
Results Pain according to the visual analog scale decreased (p = 0.01) and QuickDASH score decreased (p = 0.02) significantly after 1 year. Radiological evaluation after 12 months showed a collapse of the scaphometacarpal distance of 45% (p = 0.01). Osteolysis of the distal scaphoid pole and/or proximal metacarpal was seen in 6 out of 10 cases. Because of the osteolysis, the use of the poly-L/D-lactide scaffold was discontinued in our practice.
Conclusion In this limited series, total trapeziectomy with the use of the poly-L/D-lactide scaffold provides significant pain reduction and improvement of overall function. Radiographic evaluation shows significant collapse of the scaphometacarpal distance after 1 year and frequent signs of osteolysis. We do not encourage the use of the poly-L/D-lactide scaffold with total trapeziectomy before long-term clinical and radiological follow-ups of the osteolysis are available.
Keywordstrapeziometacarpal osteoarthritis - poly-L/D-lactide spacer - osteolysis - proximal migration
Approval of the local ethical review committee was acquired (RZ Tienen hospital). Most of the work was also done at the RZ Tienen hospital.
- 1 Kapoutsis DV, Dardas A, Day CS. Carpometacarpal and scaphotrapeziotrapezoid arthritis: arthroscopy, arthroplasty, and arthrodesis. J Hand Surg Am 2011; 36 (02) 354-366
- 2 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
- 3 Parker WL. Evidence-based medicine: thumb carpometacarpal arthroplasty. Plast Reconstr Surg 2013; 132 (06) 1706-1719
- 4 Wolf JM, Delaronde S. Current trends in nonoperative and operative treatment of trapeziometacarpal osteoarthritis: a survey of US hand surgeons. J Hand Surg Am 2012; 37 (01) 77-82
- 5 Elfar JC, Burton RI. Ligament reconstruction and tendon interposition for thumb basal arthritis. Hand Clin 2013; 29 (01) 15-25
- 6 Downing ND, Davis TR. Trapezial space height after trapeziectomy: mechanism of formation and benefits. J Hand Surg Am 2001; 26 (05) 862-868
- 7 Honkanen PB, Kellomäki M, Lehtimäki MY, Törmälä P, Mäkelä S, Lehto MU. Bioreconstructive joint scaffold implant arthroplasty in metacarpophalangeal joints: short-term results of a new treatment concept in rheumatoid arthritis patients. Tissue Eng 2003; 9 (05) 957-965
- 8 Tiihonen RP, Skyttä ET, Kaarela K, Ikävalko M, Belt EA. Reconstruction of the trapeziometacarpal joint in inflammatory joint disease using interposition of autologous tendon or poly-L-D-lactic acid implants: a prospective clinical trial. J Plast Surg Hand Surg 2012; 46 (02) 113-119
- 9 Kapandji A. Bioméchanique des articulations trapézomé- tacarpienne et scapho-trapézienne. In: Saffar P. , ed. La rhizarthrose. Vol. 30. Paris: Expansion Scientifique Française; 1990: 67-70
- 10 Honkanen PB, Kellomäki M, Konttinen YT, Mäkelä S, Lehto MU. A midterm follow-up study of bioreconstructive polylactide scaffold implants in metacarpophalangeal joint arthroplasty in rheumatoid arthritis patients. J Hand Surg Eur Vol 2009; 34 (02) 179-185
- 11 Tiihonen RP, Skyttä ET, Kaarela K, Ikävalko M, Belt EA. Reconstruction of the trapeziometacarpal joint in inflammatory joint disease using interposition of autologous tendon or poly-L-D-lactic acid implants: a prospective clinical trial. J Plast Surg Hand Surg 2012; 46 (02) 113-119
- 12 Mattila S, Waris E. Unfavourable short-term outcomes of a poly-L/D-lactide scaffold for thumb trapeziometacarpal arthroplasty. J Hand Surg Eur Vol 2016; 41 (03) 328-334
- 13 Esplugas M, Lluch-Bergada A, Mobargha N, Llusa-Perez M, Hagert E, Garcia-Elias M. Trapeziometacarpal ligaments biomechanical study: implications in arthroscopy. J Wrist Surg 2016; 5 (04) 277-283
- 14 Mattila S, Ainola M, Waris E. Bioabsorbable poly-L/D-lactide (96/4) scaffold arthroplasty (RegJoint™) for trapeziometacarpal osteoarthritis: a 3-year follow-up study. J Hand Surg Eur Vol 2018; 43 (04) 413-419
- 15 Vitale MA, Taylor F, Ross M, Moran SL. Trapezium prosthetic arthroplasty (silicone, Artelon, metal, and pyrocarbon). Hand Clin 2013; 29 (01) 37-55
- 16 Yao J, Cheah AE. Mean 5-year follow-up for suture button suspensionplasty in the treatment of thumb carpometacarpal joint osteoarthritis. J Hand Surg Am 2017; 42 (07) 569.e1-569.e11
- 17 Tomaino MM, Pellegrini Jr VD, Burton RI. Arthroplasty of the basal joint of the thumb. Long-term follow-up after ligament reconstruction with tendon interposition. J Bone Joint Surg Am 1995; 77 (03) 346-355