What are the outcomes of trapeziectomy for treating arthritis?

Outcomes of Trapeziectomy for Thumb Arthritis

Simple trapeziectomy alone is the most effective surgical treatment for thumb base osteoarthritis with fewer complications compared to more complex procedures, providing significant pain relief and improved function with long-term durability. 1

Efficacy of Trapeziectomy

Trapeziectomy is a well-established surgical treatment for thumb carpometacarpal (CMC) joint arthritis with the following outcomes:

Pain Relief

• Significant reduction in pain levels, with studies showing average pain scores decreasing from 6.2 to 0.7 on visual analog scales 2
• Consistent pain relief maintained over long-term follow-up (10+ years) 3

Functional Outcomes

• Improvement in grip strength (average 16% increase) 2
• Improvement in key pinch strength (average 19% increase) 2
• Maintained thumb mobility and range of motion
• Significant improvement in patient-reported functional outcomes on standardized measures like DASH (Disabilities of the Arm, Shoulder and Hand) questionnaires 3

Patient Satisfaction

• High rates of patient satisfaction, with studies showing 86% of patients would undergo the same procedure again 4
• Normative DASH scores (average 8.7) at long-term follow-up 3

Comparing Trapeziectomy Techniques

The EULAR guidelines provide important insights on different trapeziectomy approaches:

1. Simple Trapeziectomy vs. Complex Procedures:

   • Simple trapeziectomy is equally effective as more complex procedures for pain relief (ES = -0.17,95% CI -0.57 to 0.24) 1
   • No significant difference in functional improvement between simple and complex procedures (ES = 0.03,95% CI -0.37 to 0.44) 1
   • Complex procedures (trapeziectomy + ligament reconstruction and tendon interposition) have significantly higher complication rates (RR = 2.12,95% CI 1.24 to 3.60) 1

2. Complications by Procedure Type:

   • Simple trapeziectomy: Lower rate of complications 1
   • Complex procedures: Higher rates of tendon rupture/adhesion, scar tenderness, sensory changes, neurological complications, instability, and complex regional pain syndrome 1
   • Arthrodesis: 71% moderate to severe complications versus 29% with trapeziectomy with ligament reconstruction 4

Long-term Durability

Trapeziectomy demonstrates excellent long-term outcomes:

• Studies with 10+ years of follow-up show maintained pain relief and function 3
• Low revision rates, with many studies reporting no need for revision surgery 3
• Partial trapeziectomy shows durability even in patients with radiographic abnormalities in adjacent joints 5

Specific Technique Considerations

Partial vs. Complete Trapeziectomy

• Partial trapeziectomy preserves the scaphotrapezial joint
• Long-term follow-up (average 9 years) shows no pain at the scaphotrapezial joint despite mild radiographic changes 5
• Maintains grip and pinch strength comparable to the non-operated hand 5

Trapeziectomy with Suspension

• Addition of ligament reconstruction can help maintain thumb height and prevent subsidence
• Various techniques include APL (abductor pollicis longus) dual ligament reconstruction 3
• Radiographic studies show approximately 31% subsidence of the thumb metacarpal in the arthroplasty space 2

When to Consider Surgery

Surgery should be considered when:

• Patient has marked pain and/or disability from thumb base OA
• Conservative treatments have failed
• Symptoms are significantly impacting quality of life 1

Pitfalls and Caveats

1. Avoid unnecessary complexity: Adding ligament reconstruction and tendon interposition to simple trapeziectomy increases complications without improving outcomes 1

2. Arthrodesis concerns: Arthrodesis with plate and screws is not recommended for routine use in women 40 years or older with stage II or III trapeziometacarpal osteoarthritis due to higher complication rates 4

3. Subsidence: Some degree of metacarpal subsidence (approximately 31%) should be expected after trapeziectomy 2

4. Adjacent joint considerations: While there may be radiographic changes in adjacent joints (like the scaphotrapezial joint), these often remain asymptomatic and do not require additional intervention 5

In conclusion, trapeziectomy provides reliable, durable outcomes for thumb base arthritis with significant improvements in pain, function, and quality of life. Simple trapeziectomy appears to offer similar benefits with fewer complications compared to more complex procedures.