[Is chronic, untreated scapho-trapezoid arthrosis after resection arthroplasty of the carpometacarpal joint clinically relevant?].
Basal joint arthrosis and scapho-trapezio-trapezoid arthrosis (triscaphe-arthrosis) are common degenerative diseases with proven surgical treatment. Besides the extirpation of the trapezium during the resection-suspension arthroplasty, we have performed additional fusion of the scaphoid and the trapezoid (ST arthrodesis) in patients with heavy arthrotic changes in both locations. But the combination of these two surgical procedures results in a prolonged rehabilitation and may lead to more complications, e.g. nonunion. Thus the question arises, whether there is any clinical relevance to an untreated scapho-trapezoid arthrosis after resection-suspension arthroplasty of the carpometacarpal joint of the thumb. From 1992 to 1998, we performed resection-suspension arthroplasty of the carpometacarpal joint of the thumb without additional intervention at the scapho-trapezoid joint in 229 patients. In reviewing the perioperative X-rays of these patients, we found 55 cases with untreated arthrosis of the scapho-trapezoid joint. 36 of these patients were reviewed and re-examined. We used the wrist-score as well as new X-rays for our retrospective examination. The untreated arthrosis of the scapho-trapezoid joint does not lead to any reduction of wrist movement and only in some cases to a slight decrease of grip strength (compared with the other side). 23 of the 36 patients were free of pain. Two thirds of the reviewed patients (24 of 36) did not feel any loss of usability of the hand. Only four in 36 cases suffered a significant loss of function. The X-rays for this follow-up showed an increase in arthrotic changes of the scapho-trapezoid joint in comparison to the X-rays after the resection-suspension arthroplasty of the carpometacarpal joint of the thumb in one-third of the patients. In conclusion, in the majority of the patients there are no clinical symptoms of an untreated scapho-trapezoid arthrosis after resection-suspension arthroplasty of the carpometacarpal joint of the thumb. Individual subjective symptoms did exist, even with increased radio-morphologic changes, only in a few cases. We cannot recommend combining of the resection-suspension arthroplasty of the carpometacarpal joint of the thumb with the risky, uncomfortable fusion of the scaphoid and the trapezoid. Presently, we treat very severe arthrotic changes in both joints with a double-resection arthroplasty. These are very rare cases. If there are any advantages in this procedure, those will need to be proven in another follow-up study.
Hasselbacher
K
K
Klinik für Handchirurgie, Abteilung II, Rhön-Klinikum, Bad Neustadt/Saale.
Steffke
M
M
Kalb
K
K
D000368:Aged; D001174:Arthrodesis / Q000379:methods*; D002348:Carpal Bones / Q000000981:diagnostic imaging / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000000981:diagnostic imaging / Q000601:surgery*; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011859:Radiography; D021361:Scaphoid Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D013933:Thumb / Q000000981:diagnostic imaging / Q000601:surgery*
Ist eine verbliebene, unbehandelte ST-Arthrose nach Resektionsarthroplastik des Sattelgelenkes klinisch relevant?