[Resection arthroplasty of the carpometacarpal joint of the thumb - results of 132 cases].
BACKGROUND
Resection arthroplasty of the carpometacarpal joint of the thumb is considered to be the most frequently used surgical treatment for arthrosis of the trapeziometacarpal joint. To avoid proximalisation and to improve stability of the first metacarpal, tendon-sling resectional arthroplasties have gained general approvement. To further simplify surgery, we have used a surgical technique since 1995, that consists in a fixation of the first metacarpal with local capsular tissue.


METHODS
From 2000 to 2001, 152 resections of the trapezium were performed in 147 patients with arthrosis of the first carpometacarpal joint. 48 surgical procedures included a tendon-sling arthroplasty; in 104 cases stabilisations of the first metacarpal were achieved by fixing local radiopalmar capsular tissue to the flexor-carpi-radialis tendon. After a mean follow-up of 30 months (18 to 41 months), patients were asked to complete a questionnaire concerning pain, physical strength, practical skills, maximal physical capacity and aesthetic result. The general surgical result had to be scored and the recovery time until the thumb could be used for activities of daily living had to be recorded.


RESULTS
132 of 152 questionnaires, 43 of the patients with tendon-sling arthroplasty and 89 of the patients with arthroplasty with local radiopalmar capsular tissue, were returned. After tendon-sling arthroplasty, 69.8 % of the patients judged their results to be good or very good, after stabilisation with radiopalmar capsular tissue 69.7 % of the patients valued their surgical results good or very good. Unsatisfactory results were found in 18.6 % of the patients after tendon-sling arthroplasty and in 19.1 % of the patients after stabilisation with radiopalmar capsular tissue. The thumb could be used for every-day life after a mean time of 6.7 months. There was no significant difference between the operative procedures.


CONCLUSIONS
The collected data implies that resection-arthroplasty of the carpometacarpal joint of the thumb with stabilisation by radiopalmar capsular tissue yields similar results compared to tendon-sling arthroplasty.
Meyer
J
J
Abteilung für Plastische und Handchirurgie (Ltd. Arzt: Prof. Dr. M. Wannske), Klinikum Lippe-Lemgo, Lemgo. friedbert.kretschmer@klinikum-lippe.de.
Kretschmer
F
F
Brocks
M
M
Wannske
M
M
D000203:Activities of Daily Living / Q000145:classification; D000328:Adult; D000368:Aged; D001178:Arthroplasty; D002348:Carpal Bones / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D017746:Joint Capsule / Q000601:surgery; D008297:Male; D008663:Metacarpus / Q000601:surgery*; D008875:Middle Aged; D010003:Osteoarthritis / Q000601:surgery*; D010043:Outcome and Process Assessment, Health Care; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000175:diagnosis*; D011795:Surveys and Questionnaires; D013709:Tendon Transfer; D013933:Thumb / Q000601:surgery*; D016474:Weight-Bearing / Q000502:physiology