A distraction arthroplasty of the trapeziometacarpal joint was introduced by Bufalini and Perugia for the treatment of the early stages of carpometacarpal osteoarthritis. Our retrospective study presents the results of this technique. Thereby, a tendon graft anchored to the distal second metacarpal is fixed at the base of the first metacarpal, keeping it in distraction.
10 distraction arthroplasties were performed in 9 patients with carpometacarpal osteoarthritis stage I and II of the thumb after unsuccessful conservative therapy. In 2 cases, which were excluded from our study, trapeziectomy had to be performed because of persisting pain. Patient satisfaction, pain measurement, range of motion, and tip, key and grip strength were evaluated at a follow-up of 46.5 (29-63) months in the remaining 7 patients (8 operations overall). Strengh measurement was taken in an absolute value and compared to the opposite side. Thumb range of motion was measured with the combined flexion-opposition of the thumb with the Kapandij index and also the angle of abduction of the metacarpal I to metacarpal II. Assessment included a DASH score evaluation and an X-ray control.
All of the 7 evaluated patients were satisfied with the operation results. Compared to the opposite side, patients achieved 80.1% (5.9 kg±1.1 kg) of key pinch strength, 86.3% (4.8 kg±0.9 kg) of oppositional tip pinch strength, and 86.1% (23.1 kg±4.8 kg) of grip strength. In combined flexion and opposition a Kapandij index of 8.5 (94.4%) compared to 9 on the opposite side was achieved. Thumb radial abduction was 48.2°±2.8°, compared to 51.0°±2.9° on the contralateral hand. At follow-up, the mean DASH score was 17.8 (±10.0). Radiological control showed no progression of carpometacarpal osteoarthritis of the thumb.
The collected data after distraction arthroplasty according to Bufalini and Perugia confirm the efficacy of the technique in the early stage of carpometacarpal osteoarthritis of the thumb. Even though a failure rate of 20% occurred, in our opinion the operation is justified in the early stages of carpometacarpal osteoarthritis of the thumb as the patients benefit from a pain-free interval, leaving the option for future trapeziectomy.