J Wrist Surg 2021; 10(06): 528-532
DOI: 10.1055/s-0041-1729992
Scientific Article

Scaphotrapezoid Assessment during Thumb Carpometacarpal Arthroplasty: A Cadaveric Study

1   Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
2   Division of Hand Surgery, The Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
,
1   Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
2   Division of Hand Surgery, The Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
,
1   Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
2   Division of Hand Surgery, The Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
,
Christopher Jones
1   Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
2   Division of Hand Surgery, The Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
,
1   Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
2   Division of Hand Surgery, The Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
› Author Affiliations

Abstract

Background Due to limited sensitivity of radiographs for scaphotrapeziotrapezoid (STT) arthritis and the high rate of concurrence between thumb carpometacarpal (CMC) and STT arthritis, intraoperative visualization of the STT joint is recommended during CMC arthroplasty.

Purpose We quantified the percentage of trapezoid facet of the scaphotrapezoid (ST) joint that could be visualized during this approach, and compared it to the degree of preoperative radiographic STT arthritis.

Methods We performed dorsal surgical approach to the thumb CMC joint after obtaining fluoroscopic anteroposterior, lateral, and oblique wrist radiographs of 11 cadaver wrists. After trapeziectomy, the ST joint was inspected and the visualized portion of the trapezoid articulation marked with an electrocautery. The trapezoid was removed, photographed, and the marked articular surface area and total surface area were independently measured by two authors using an image analysis software. The radiographs were analyzed for the presence of STT arthritis.

Results The mean visualized trapezoid surface area during standard approach for CMC arthroplasty was 60.3% (standard deviation: 24.6%). The visualized percentage ranged widely from 16.7 to 96.5%. There was no significant correlation between degree of radiographic arthritis and visualized percentage of the joint (p = 0.77).

Conclusions: On average, 60% of the trapezoid joint surface was visualized during routine approach to the thumb CMC joint, but with very large variability. Direct visualization of the joint did not correlate with the degree of radiographic STT arthritis.

Clinical Relevance A combination of clinical examination, pre- and intraoperative radiographs, and intraoperative visualization should be utilized to assess for STT osteoarthritis and determine the need for surgical treatment.

Level of Evidence This is a Cadaveric Research Article.

Note

The work was performed at The Rothman Orthopaedic Institute, 925 Chestnut St, 5th Floor, Philadelphia PA 19107.


Ethical Approval

This study was deemed exempt from review by our institution.




Publication History

Received: 26 July 2020

Accepted: 06 April 2021

Article published online:
11 June 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Haugen IK, Englund M, Aliabadi P. et al. Prevalence, incidence and progression of hand osteoarthritis in the general population: the Framingham Osteoarthritis Study. Ann Rheum Dis 2011; 70 (09) 1581-1586
  • 2 Haara MM, Heliövaara M, Kröger H. et al. Osteoarthritis in the carpometacarpal joint of the thumb. Prevalence and associations with disability and mortality. J Bone Joint Surg Am 2004; 86 (07) 1452-1457
  • 3 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
  • 4 Tomaino MM, Vogt M, Weiser R. Scaphotrapezoid arthritis: prevalence in thumbs undergoing trapezium excision arthroplasty and efficacy of proximal trapezoid excision. J Hand Surg Am 1999; 24 (06) 1220-1224
  • 5 Bhatia A, Pisoh T, Touam C, Oberlin C. Incidence and distribution of scaphotrapezotrapezoidal arthritis in 73 fresh cadaveric wrists. Ann Chir Main Memb Super 1996; 15 (04) 220-225
  • 6 Brown III GD, Roh MS, Strauch RJ, Rosenwasser MP, Ateshian GA, Mow VC. Radiography and visual pathology of the osteoarthritic scaphotrapezio-trapezoidal joint, and its relationship to trapeziometacarpal osteoarthritis. J Hand Surg Am 2003; 28 (05) 739-743
  • 7 Papatheodorou LK, Winston JD, Bielicka DL, Rogozinski BJ, Lourie GM, Sotereanos DG. Revision of the failed thumb carpometacarpal arthroplasty. J Hand Surg Am 2017; 42 (12) 1032.e1-1032.e7
  • 8 Wolf JM. Treatment of scaphotrapezio-trapezoid arthritis. Hand Clin 2008; 24 (03) 301-306 , vii
  • 9 Schneider CA, Rasband WS, Eliceiri KW. NIH Image to ImageJ: 25 years of image analysis. Nat Methods 2012; 9 (07) 671-675
  • 10 White L, Clavijo J, Gilula LA, Wollstein R. Classification system for isolated arthritis of the scaphotrapeziotrapezoidal joint. Scand J Plast Reconstr Surg Hand Surg 2010; 44 (02) 112-117
  • 11 Watson HK, Ballet FL. The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis. J Hand Surg Am 1984; 9 (03) 358-365
  • 12 Bade H, Koebke J. Arthrosis in the peritrapezial joints of the hand. Surg Radiol Anat 1996; 18 (03) 209-214
  • 13 Crosby EB, Linscheid RL, Dobyns JH. Scaphotrapezial trapezoidal arthrosis. J Hand Surg Am 1978; 3 (03) 223-234
  • 14 Moritomo H, Viegas SF, Nakamura K, Dasilva MF, Patterson RM. The scaphotrapezio-trapezoidal joint. Part 1: an anatomic and radiographic study. J Hand Surg Am 2000; 25 (05) 899-910
  • 15 Martini K, Becker AS, Guggenberger R, Andreisek G, Frauenfelder T. Value of tomosynthesis for lesion evaluation of small joints in osteoarthritic hands using the OARSI score. Osteoarthritis Cartilage 2016; 24 (07) 1167-1171