Comparing Two Reconstructive Surgeries for Thumb ArthritisArthritis of the thumb is a common problem in the older adult. Women are affected twice as often as men. Treatment is usually with conservative measures. But when pain and stiffness affect daily function, then surgery may be considered. Fusion or joint replacement are two possible choices. But removing the arthritic bone and replacing it with a piece of tendon may be a better choice.
In this study, two different reconstructive methods for basal (thumb) joint arthritis are compared. The main difference between the two operations is in how much bone is removed. In the first operation (ligament reconstruction tendon interposition (LRTI)), the entire trapezium bone at the base of the thumb is taken out. In the second procedure (trapeziometacarpal interposition arthroplasty (TMIA)), only enough bone to smooth the joint surface was removed.
LRTI is usually done on patients with the most severe arthritis (stage IV). Mild to moderate cases (stages II and III) are treated with TMIA. Results of the two operations were measured based on range of motion, grip and pinch strength, and function. Other measures included pain and/or tenderness, amount of medications taken for pain relief, and patient satisfaction.
The results showed no difference in motion or function between the two groups. This was true even for those patients in the LRTI group who experienced shortening of the thumb. Pinch strength did not seem to be linked with thumb shortening either.
Several patients in the TMIA group had to have a second operation later to convert the patient to a LRTI. The authors reported a high rate of revision surgeries for the TMIA group. They suggest this procedure is better suited for younger patients with a greater need for pinch strength. Both groups had equal satisfaction rates despite differences in outcomes.
Patients with stage II or III thumb joint arthritis may be able to benefit from either one of these two reconstructive surgeries. After examining the patient and looking carefully at the joint surfaces, the surgeon will decide between LRTI and TMIA. The TMIA limits how much thumb shortening can occur. But from the results of this study, it's not clear that bone migration resulting in thumb shortening is a problem that affects function in any measurable way. For severe (stage IV) basal arthritis, LRTI is advised.
Louis Catalano, MD, et al. Comparison of Ligament Reconstruction Tendon Interposition and Trapeziometacarpal Interposition Arthroplasty for Basal Joint Arthritis. In Orthopedics. March 2008. Vol. 31. No. 3. Pp. 228.
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