Trapeziectomy vs LRTI (5-18 year follow-up)

Five- to 18-year follow-up for treatment of trapeziometacarpal osteoarthritis: a prospective comparison of excision, tendon interposition, and ligament reconstruction and tendon interposition

Gangopadhyay S, McKenna H, Burke FD, et al. The Journal of hand surgery 2012 · PMID 22305824 · doi:10.1016/j.jhsa.2011.11.027

Question

Does adding tendon interposition or ligament reconstruction to trapeziectomy improve long-term outcomes in base of thumb osteoarthritis?

Design

Long-term follow-up of a UK randomised trial comparing three trapeziectomy techniques.

Patients

Patients with symptomatic trapeziometacarpal (base of thumb) osteoarthritis treated surgically.

Intervention

Trapeziectomy with palmaris longus interposition, or with flexor carpi radialis ligament reconstruction and tendon interposition (LRTI)

Comparison

Simple trapeziectomy

Primary outcome

Pain relief, function, strength and range of movement at a minimum of 5 years

Key result

There were no significant differences in pain, grip or pinch strength or movement between the three techniques; good pain relief was maintained over time, although pinch strength declined regardless of procedure.

Limitations

Single-centre trial with some loss to follow-up over a long period.

Impact on practice

Shows that simple trapeziectomy is as effective long term as more complex interposition or LRTI procedures, so many UK surgeons favour simple excision.