Download PDF
CC BY 4.0 · Surg J (N Y) 2019; 05(03): e120-e125
DOI: 10.1055/s-0039-1697635
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Trapeziometacarpal Joint Arthroplasty of the Thumb without Osseous Tunnels and Carpal Tunnel Release via a Radial Approach; Technique, and Results

Chung Ming Chan
1   Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida
,
Efraín Farías Cisneros
2   Department of Orthopedics, Hospital Español de México, Mexico City, Mexico
,
Tsu-Min Tsai
3   Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, Kentucky
› Author Affiliations Funding The author(s) received no financial support for the research, authorship, and/or publication of this article.
Further Information

Publication History

21 November 2018

07 August 2019

Publication Date:
24 September 2019 (online)

   Permissions and Reprints

Correction to:

Erratum: Trapeziometacarpal Joint Arthroplasty of the Thumb without Osseous Tunnels and Carpal Tunnel Release via a Radial Approach; Technique, and ResultsSurg J (N Y) 2019; 05(03): e1-e1
DOI: 10.1055/s-0039-1700493

Abstract

Background Numerous surgeries have been described for osteoarthritis of the trapeziometacarpal (TMC) joint. We describe the senior author's experience with his technique of concurrent arthroplasty of the TMC joint, and carpal tunnel release (CTR) via a radial approach.

Methods The study is a case series of patients managed over a 3-year period. We included 86 patients over 40 years of age that had concurrent CTR. We used the paired t-test to compare the preoperative and postoperative grip strength and functional scoring (including the Levine-Katz questionnaire for carpal tunnel syndrome, disabilities of the arm shoulder and hand [DASH] score and QuickDASH9).

Results Mean age at surgery was 62.8 years, and mean follow-up was 13.1 months. Functional outcomes were analyzed in 65 patients. Grip strength returned to the preoperative measurement by 3 months. Analysis of the nine patients followed up for more than 13 months postoperatively showed a significant increase in grip strength at last follow-up. The grip strength in both hands was also similar beyond 13 months. Significant decreases in the functional scores recorded indicated a reduction in disability, symptom severity, and functional impairment.

Conclusions In conclusion, we present the favorable results of this technique of TMC arthroplasty and CTR involving no bone tunnels and short-term immobilization.

Keywords

arthritis - arthroplasty - carpometacarpal joint - thumb - trapeziectomy

Ethical Approval

This study was a retrospective cohort study conducted under approval of the institutional review board of the senior author's institution.


Statement of Human and Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation Helsinki Declaration of 1975, as revised in 2008.


Statement of Informed Consent

Informed consent was obtained from all individual participants included in the study.


Note

Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements) that might pose a conflict of interest in connection with the submitted article.


Each author certifies that his or her institution approved the human protocol for this investigation, and that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.


This work was performed at the Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, Kentucky, USA.


 

  • References

  • 1 Berger AJ, Meals RA. Management of osteoarthrosis of the thumb joints. J Hand Surg Am 2015; 40 (04) 843-850
    CrossrefPubMedGoogle Scholar
  • 2 Matullo KS, Ilyas A, Thoder JJ. CMC arthroplasty of the thumb: a review. Hand (N Y) 2007; 2 (04) 232-239
    CrossrefPubMedGoogle Scholar
  • 3 Belcher HJ, Nicholl JE. A comparison of trapeziectomy with and without ligament reconstruction and tendon interposition. J Hand Surg [Br] 2000; 25 (04) 350-356
    CrossrefPubMedGoogle Scholar
  • 4 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
    CrossrefPubMedGoogle Scholar
  • 5 Davis TR, Brady O, Barton NJ, Lunn PG, Burke FD. Trapeziectomy alone, with tendon interposition or with ligament reconstruction?. J Hand Surg [Br] 1997; 22 (06) 689-694
    CrossrefPubMedGoogle Scholar
  • 6 Thompson JS. Complications and salvage of trapeziometacarpal arthroplasties. Instr Course Lect 1989; 38: 3-13
    PubMedGoogle Scholar
  • 7 Li YK, White C, Ignacy TA, Thoma A. Comparison of trapeziectomy and trapeziectomy with ligament reconstruction and tendon interposition: a systematic literature review. Plast Reconstr Surg 2011; 128 (01) 199-207
    CrossrefPubMedGoogle Scholar
  • 8 Vermeulen GM, Slijper H, Feitz R, Hovius SER, Moojen TM, Selles RW. Surgical management of primary thumb carpometacarpal osteoarthritis: a systematic review. J Hand Surg Am 2011; 36 (01) 157-169
    CrossrefPubMedGoogle Scholar
  • 9 Shin CH, Paik NJ, Lim JY. , et al. Carpal tunnel syndrome and radiographically evident basal joint arthritis of the thumb in elderly Koreans. J Bone Joint Surg Am 2012; 94 (16) e1201-e1206
    CrossrefPubMedGoogle Scholar
  • 10 Florack TM, Miller RJ, Pellegrini VD, Burton RI, Dunn MG. The prevalence of carpal tunnel syndrome in patients with basal joint arthritis of the thumb. J Hand Surg Am 1992; 17 (04) 624-630
    CrossrefPubMedGoogle Scholar
  • 11 Weber RA, Sanders WE. Flexor carpi radialis approach for carpal tunnel release. J Hand Surg Am 1997; 22 (01) 120-126
    CrossrefPubMedGoogle Scholar
  • 12 Levine DW, Simmons BP, Koris MJ. , et al. A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am 1993; 75 (11) 1585-1592
    CrossrefPubMedGoogle Scholar
  • 13 Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant 2013; 48 (03) 452-458
    CrossrefPubMedGoogle Scholar
  • 14 Tsai TM, Laurentin-Perez LA, Wong MS, Tamai M. Ideas and innovations: radial approach to carpal tunnel release in conjunction with thumb carpometacarpal arthroplasty. Hand Surg 2005; 10 (01) 61-66
    CrossrefPubMedGoogle Scholar
  • 15 Hepinstall MS, Yang SS. Indirect decompression of the carpal tunnel during basal joint arthroplasty of the thumb. J Hand Surg Am 2008; 33 (07) 1057-1062
    CrossrefPubMedGoogle Scholar
  • 16 Ingari JV, Romeo N. Basal joint arthroplasty and radial-sided carpal tunnel release using a single incision. Tech Hand Up Extrem Surg 2015; 19 (04) 157-160
    CrossrefPubMedGoogle Scholar
  • 17 Graham B. The value added by electrodiagnostic testing in the diagnosis of carpal tunnel syndrome. J Bone Joint Surg Am 2008; 90 (12) 2587-2593
    CrossrefPubMedGoogle Scholar
  • 18 Franchignoni F, Vercelli S, Giordano A, Sartorio F, Bravini E, Ferriero G. Minimal clinically important difference of the disabilities of the arm, shoulder and hand outcome measure (DASH) and its shortened version (QuickDASH). J Orthop Sports Phys Ther 2014; 44 (01) 30-39
    CrossrefPubMedGoogle Scholar
  • 19 Sorensen AA, Howard D, Tan WH, Ketchersid J, Calfee RP. Minimal clinically important differences of 3 patient-rated outcomes instruments. J Hand Surg Am 2013; 38 (04) 641-649
    CrossrefPubMedGoogle Scholar
  • 20 Ozyürekoğlu T, McCabe SJ, Goldsmith LJ, LaJoie AS. The minimal clinically important difference of the carpal tunnel syndrome symptom severity scale. J Hand Surg Am 2006; 31 (05) 733-738 , discussion 739–740
    CrossrefPubMedGoogle Scholar