This article compares thumb trapeziometacarpal joint arthrodesis with ligament reconstruction and tendon interposition (LRTI) for osteoarthritis of the thumb trapeziometacarpal joint. 42 patients (58 thumbs) were treated with arthrodesis compared with 39 patients (49 thumbs) that underwent LRTI. All patients completed a questionnaire, and most patients were examined with radiographs at an average follow-up of 69 months. Subjective evaluation of pain, function, and satisfaction revealed similar results with 98 percent satisfaction in the arthrodesis group and 92 percent in the LRTI group. Grip and tip pinch strength were similar in each group, however, the arthrodesis group did have slight but statistically significant stronger lateral pinch and chuck pinch strength than the LRTI group. The arthrodesis group also had significantly increased motion of the metacarpophalangeal joint, but no significant difference in interphalangeal joint motion. Opposition and the ability to flatten the hand was significantly better in the LRTI group. Ability and timing of return to work were similar. There was a higher complication rate in the arthrodesis group, with a 16 percent non-union rate. Six patients had persistent non-unions, but they reported either no pain or occasional pain, and all were satisfied with their outcome. Peritrapezial degenerative changes were noted in 14 of 44 thumbs following arthrodesis.
This study confirms similarly good results in patients less than 60 years of age treated with either arthrodesis or LRTI. Although there were slight differences which tended towards improved motion in the LRTI group and improved strength in the arthrodesis group, greater than 90 percent of all patients were satisfied with either procedure. The higher complication rate in the arthrodesis group was mostly related to non-unions which were minimized later in the series when a 2.0 mini condylar blade plate was routinely used. Overall, this study confirms the equal efficacy of the use of arthrodesis and LRTI even in relatively young patients with trapeziometacarpal joint arthritis.