Arthroplasty of the trapeziometacrpal joint. A study of 36 cases

This retrospective study was done during the period 1998 - 2002 to evaluate two types of surgeries for symptomatic osteoarthritis of the trapeziometacarpal joint at the base of the thumb in 36 hands. There were 19 females and 7 males. Follow up period ranged from 18 to 39 months [mean 32 months]. The study reviewed fifteen [41.7%] hands treated by tendon interposition arthroplasty with ligamentoplasty and twenty one [58.3%] hands treated by silicone replacement arthroplasty. The clinical outcome was measured depending on the assessment of pain, function, movement and strength. Radiologic follow up was done for proximal shift of the thumb metacarpal as well as signs of implant instability or wear. For this short term follow up, there was no significant difference regarding the power, movement, or function between either groups. In the tendon interposition arthroplasty group; pain relief was much better, no significant complications and the ultimate clinical score was excellent [36 points]. In the silicone replacement group; the clinical score was good [32 points] and complication rate was high with four implant dislocations [19%] and two symptomatic synovitis [9.5%]. Six hands of the silicone replacement group [28.5%] needed revision by removal of the implant while in the tendon interposition group no revision was needed