TY - JOUR
T1 - Locking Plate Arthrodesis Compares Favorably with LRTI for Thumb Trapeziometacarpal Arthrosis
T2 - Early Outcomes from a Longitudinal Cohort Study
AU - Kazmers, Nikolas H.
AU - Hippensteel, K. J.
AU - Calfee, Ryan P.
AU - Wall, Lindley B.
AU - Boyer, Martin I.
AU - Goldfarb, Charles A.
AU - Gelberman, Richard H.
AU - Osei, Daniel A.
N1 - Funding Information:
This publication was supported by the Institute of Clinical and Translational Sciences Award program of the National Center for Advancing Translational Sciences (NCATS) at the National Institutes of Health (NIH), grant numbers UL1 TR000448, KL2TR000450.
Funding Information:
Nikolas H. Kazmers, MD, MSE; Kirk J. Hippensteel, MD; and Lindley B. Wall, MD have declared that they have no conflict of interest. Charles A. Goldfarb, MD reports personal fees from Wolters-Kluwer Publishing, independent Expert witness, and ASSH Board Meetings, outside the work. Richard H. Gelberman, MD reports personal fees from JBJS Board of Trustees and Healthpoint Capital: Member of the Scientific Advisory Board, grants from the National Institutes of Health R01 AR062947 and personal fees from Wolters-Kluwer and Medartis, outside the work. Daniel A. Osei, MD, MSc reports grants from NIH KL2 Training Grant, during the conduct of the study. Ryan P. Calfee, MD, MSc reports grants from ASSH and Medartis and personal fees from Depuy/Synthes, outside the work. Martin I. Boyer, MD, MSc reports personal fees from OrthoHelix, Acumed, LLC, Hand Surgical Medicolegal Consultation, LLC, Wolters-Kluwer Publishing, Tournier, and OrthoHelix, outside the work.
Publisher Copyright:
© 2016, Hospital for Special Surgery.
PY - 2017/2/1
Y1 - 2017/2/1
N2 - Background: Trapeziometacarpal arthrodesis (TMA) has been complicated by nonunion and hardware failure. Questions/Purposes: We hypothesized that modification of the TMA technique with a locking cage plate construct would afford reliable bony union while producing greater hand function than trapeziectomy with ligament reconstruction and tendon interposition (LRTI) at early follow-up. Methods: We enrolled 36 consecutive patients with trapeziometacapal osteoarthritis (14 TMA patients (15 thumbs), 22 LRTI patients (22 thumbs)). The study was powered to detect a minimal clinically important difference on the QuickDASH questionnaire between groups. Secondary outcomes included Michigan Hand Questionnaire (MHQ), VAS-pain, and EQ-5D-3L scores. Patients were examined to evaluate thumb motion and strength. TMA patients were evaluated clinically and radiographically for union. Results: Mean follow-up was 15.6 months, and the mean age was 59.2 years. Union was achieved in 14/15 (93%) of TMA thumbs. Improvement in QuickDASH scores was similar after TMA and LRTI (49 to 28 and 50 to 18, respectively). Postoperative patient-rated upper extremity function, health status, and pain were similar between groups. Pinch strength was significantly greater after TMA (5.9 vs 4.7 kg). No differences in thumb or wrist range of motion were observed postoperatively with the exception of greater total metacarpophalangeal joint motion after TMA. Complications after TMA included nonunion (7%), development of symptomatic scaphotrapezotrapezoidal (STT) arthrosis (7%), symptomatic hardware (7%), and superficial branch of the radial nerve (SBRN) paresthesia (7%). Complications after LRTI included subsidence (5%), MP hyperextension deformity (5%), and SBRN paresthesias (5%). Conclusions: At early follow-up, patient-rated function was similar among patients undergoing TMA and LRTI. TMA produced 25% greater pinch strength compared with LRTI. Despite historical concerns regarding global loss of ROM with arthrodesis, motion was similar between groups. Our observed TMA nonunion rate of 7% is low relative to historically reported nonunion rates (7–16%). Locking cage plate technology affords rigid fixation for TMA with promising early results noting reliable bony union while minimizing complications.
AB - Background: Trapeziometacarpal arthrodesis (TMA) has been complicated by nonunion and hardware failure. Questions/Purposes: We hypothesized that modification of the TMA technique with a locking cage plate construct would afford reliable bony union while producing greater hand function than trapeziectomy with ligament reconstruction and tendon interposition (LRTI) at early follow-up. Methods: We enrolled 36 consecutive patients with trapeziometacapal osteoarthritis (14 TMA patients (15 thumbs), 22 LRTI patients (22 thumbs)). The study was powered to detect a minimal clinically important difference on the QuickDASH questionnaire between groups. Secondary outcomes included Michigan Hand Questionnaire (MHQ), VAS-pain, and EQ-5D-3L scores. Patients were examined to evaluate thumb motion and strength. TMA patients were evaluated clinically and radiographically for union. Results: Mean follow-up was 15.6 months, and the mean age was 59.2 years. Union was achieved in 14/15 (93%) of TMA thumbs. Improvement in QuickDASH scores was similar after TMA and LRTI (49 to 28 and 50 to 18, respectively). Postoperative patient-rated upper extremity function, health status, and pain were similar between groups. Pinch strength was significantly greater after TMA (5.9 vs 4.7 kg). No differences in thumb or wrist range of motion were observed postoperatively with the exception of greater total metacarpophalangeal joint motion after TMA. Complications after TMA included nonunion (7%), development of symptomatic scaphotrapezotrapezoidal (STT) arthrosis (7%), symptomatic hardware (7%), and superficial branch of the radial nerve (SBRN) paresthesia (7%). Complications after LRTI included subsidence (5%), MP hyperextension deformity (5%), and SBRN paresthesias (5%). Conclusions: At early follow-up, patient-rated function was similar among patients undergoing TMA and LRTI. TMA produced 25% greater pinch strength compared with LRTI. Despite historical concerns regarding global loss of ROM with arthrodesis, motion was similar between groups. Our observed TMA nonunion rate of 7% is low relative to historically reported nonunion rates (7–16%). Locking cage plate technology affords rigid fixation for TMA with promising early results noting reliable bony union while minimizing complications.
KW - LRTI
KW - basal joint arthritis
KW - fusion
KW - thumb CMC
KW - trapeziometacarpal
UR - http://www.scopus.com/inward/record.url?scp=84991088916&partnerID=8YFLogxK
U2 - 10.1007/s11420-016-9527-3
DO - 10.1007/s11420-016-9527-3
M3 - Article
C2 - 28167875
AN - SCOPUS:84991088916
SN - 1556-3316
VL - 13
SP - 54
EP - 60
JO - HSS Journal
JF - HSS Journal
IS - 1
ER -