The authors performed a prospective study comparing 2 operations for basal joint osteoarthritis: trapeziectomy with ligament reconstruction, tendon interposition, and temporary pinning (LRTI), and excision of the trapezium alone without pinning. There were 61 thumbs in the LRTI group and 67 thumbs in the trapeziectomy alone group. Follow-up measurements were obtained at a mean of 3- months and 1-year after surgery.
Dash scores, Patient Evaluation Measure scores, and key and tip pinch measurements did not differ significantly between the 2 groups at 3-months or 1-year after surgery. Most patients in both groups reported no pain or transient activity-related aching pain at the final assessment. Four patients in the trapeziectomy alone group had dorsal subluxation of the pseudarthrosis on follow-up radiographs: 2 of these patients were symptomatic, one of whom underwent an LRTI procedure without benefit.
The findings from this study lend support to trapeziectomy alone, without temporary metacarpal pinning, in the surgical management of basal joint arthritis. The authors asserted their opinion that secure capsular closure over the trapeziectomy void may prevent dorsal subluxation of the metacarpal base. The clinical relevance of proximal migration of the thumb metacarpal after trapeziectomy remains in question, as symptomatic scaphometacarpal impingement has been infrequently reported (Field and Buchanan, JHS E, 2007).