Long-term effects of carpometacarpal joint arthrodesis on pain, clinical functions and quality of life

Abstract

The aim of this study was to evaluate the effect on pain and functional results, and potential complications, of arthrodesis applied to the carpometacarpal (CMC) joint of the thumb because of osteoarthritis. This single-centre, retrospective study included patients who presented at the polyclinic between 2003 and 2018 with complaints of pain and/or deformity at the base of the thumb, clinically and radiographically consistent with osteoarthritis of the CMC joint of the thumb. Before treatment and at the final examination, pain at rest and during activity (daily living activities) was evaluated with a visual analog scale (VAS), and the functional results were evaluated with the patient-reported DASH and PRWE scores. The study included 26 patients with a mean age of 55.4 years and mean follow-up period of 8.3 ± 4.1 years. Surgery was performed on the dominant hand in 73.1% of the patients. A significant improvement was determined postoperatively with mean VAS score of 3.5 (IQR: 2 - 5), mean DASH score of 26.1 (IQR: 20.5- 37.0), and mean PRWE score of 22.5 (IQR: 15.1–29.6). In the cases with surgery applied to the non-dominant hand, no significant correlation was determined postoperatively between the PRWE function score and VAS (p=0.053). In one patient applied with revision surgery with autograft because of pseudarthrosis during follow-up, there were complaints of pain because of the development of osteophytes. Patients applied with arthrodesis for osteoarthritis of the thumb CMC joint, showed a high level of satisfaction in the long-term follow up measured with DASH and PRWE. In the light of these results, arthrodesis for osteoarthritis of the thumb CMC joint can be evaluated as a reliable and effective treatment method.

Keywords

• carpometacarpal
• osteoarthritis
• arthrodesis
• basal thumb joint
• pain

References

1. 1. Van Heest AE, Kallemeier P. Thumb carpal metacarpal arthritis. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2008;16(3):140-51.
2. 2. Neumann DA, Bielefeld T. The carpometacarpal joint of the thumb: stability, deformity, and therapeutic intervention. Journal of Orthopaedic & Sports Physical Therapy. 2003;33(7):386-99.
3. 3. Armstrong A, Hunter J, Davis T. The prevalence of degenerative arthritis of the base of the thumb in post-menopausal women. Journal of hand surgery. 1994;19(3):340-1.
4. 4. Varley G, Calvey J, Hunter J, Barton N, Davis T. Excision of the trapezium for osteoarthritis at the base of the thumb. The Journal of Bone and Joint Surgery British volume. 1994;76(6):964-8.
5. 5. Earp BE, Leung AC, Blazar PE, Simmons BP. Arthroscopic hemitrapeziectomy with tendon interposition for arthritis at the first carpometacarpal joint. Techniques in hand & upper extremity surgery. 2008;12(1):38-42.
6. 6. Müller G. Arthrodesis of the trapezio-metacarpal joint for osteoarthritis. The Journal of Bone and Joint Surgery British volume. 1949;31(4):540-2.
7. 7. Rizzo M, Moran SL, Shin AY. Long-term outcomes of trapeziometacarpal arthrodesis in the management of trapeziometacarpal arthritis. The Journal of hand surgery. 2009;34(1):20-6.
8. 8. Rubino M, Civani A, Pagani D, Sansone V. Trapeziometacarpal narrow pseudarthrosis: a new surgical technique to treat thumb carpometacarpal joint arthritis. Journal of Hand Surgery (European Volume). 2013;38(8):844-50.

9. 9. Smeraglia F, Soldati A, Orabona G, Ivone A, Balato G, Pacelli M. Trapeziometacarpal arthrodesis: is bone union necessary for a good outcome? Journal of Hand Surgery (European Volume). 2015;40(4):356-61.
10. 10. Fulton DB, Stern PJ. Trapeziometacarpal arthrodesis in primary osteoarthritis: a minimum two-year follow-up study. The Journal of hand surgery. 2001;26(1):109-14.
11. 11. De Smet L, Vaes F, Van Den Broecke J. Arthrodesis of the trapeziometacarpal joint for basal joint osteoarthritis of the thumb: the importance of obtaining osseous union. Chirurgie de la main. 2005;24(5):222-4.
12. 12. Raven E, Kerkhoffs G, Rutten S, Marsman A, Marti R, Albers G. Long term results of surgical intervention for osteoarthritis of the trapeziometacarpal joint. International orthopaedics. 2007;31(4):547-54.
13. 13. van Laarhoven CM, Schrier VJ, van Heijl M, Schuurman AH. Arthrodesis of the carpometacarpal thumb joint for osteoarthritis; long-term results using patient-reported outcome measurements. Journal of Wrist Surgery. 2019;8(06):489-96.
14. 14. Spekreijse KR, Selles RW, Kedilioglu MA, Slijper HP, Feitz R, Hovius SE, et al. Trapeziometacarpal arthrodesis or trapeziectomy with ligament reconstruction in primary trapeziometacarpal osteoarthritis: a 5-year follow-up. The Journal of Hand Surgery. 2016;41(9):910-6.
15. 15. Singh H, Hoare C, Beresford-Cleary N, Anakwe R, Hayton M. Nonunion after trapeziometacarpal arthrodesis: comparison between K-wire and internal fixation. Journal of Hand Surgery (European Volume). 2015;40(4):351-5.
16. 16. Carroll RE. Arthrodesis of the carpometacarpal joint of the thumb. A review of patients with a long postoperative period. Clinical Orthopaedics and Related Research. 1987(220):106-10.
17. 17. Clough DA, Crouch CC, Bennett JB. Failure of trapeziometacarpal arthrodesis with use of the Herbert screw and limited immobilization. The Journal of hand surgery. 1990;15(5):706-11.
18. 18. Mattsson H. Arthrodesis of the first carpo-metacarpal joint for osteoarthritis. Acta Orthopaedica Scandinavica. 1969;40(5):602-7.