The authors deal with surgical treatment of osteoarthritis of carpometacarpal joint of the thumb. They present results of three different techniques of interposition arthroplasty.
Thirteen operations were carried out in the period of 1997-1999 in 12 patients (9 women and 3 men). In seven cases the dominant right hand was affected, in 4 cases the left hand was involved. The average age was 56 years (range, 48-91 years). In none of the patients any extreme activity of the operated on hand is expected in future.
The surgical treatment consists in resection of damaged articular surface and interposition of soft tissue. In Nalebuff-Millender operation the graft is taken from the tendon of m. palmaris longus (PL). In the operation after Burton and Pellegrini the graft is formed by the longitudinal half of the tendon of m. flexor carpi radialis (FCR). The tendon is fixed to the Ist metacarpal by its pulling through a channel drilled in the base of the metacarpal. In Wulle operation the interposition tissue is harvested from the longitudinal half of tendon of m. abductor pollicis longus (APL) wound around FCR tendon. During the operation after Nalebuff-Millender we performed in the first 3 patients partial resection of trapezium, in all other cases total resection of trapezium. The thumb was fixed for three weeks with a subsequent physiotherapy. The results were evaluated according to a three-grade classification--excellent, good, poor (fully functional, partially functional and non-functional hand) according to tenderness, strength of grip and abduction range of the thumb.
In 7 patients after Nalebuff-Millender operation the result was twice excellent and five times good. Among 5 good results were three patients with partial resection of trapezium. The condition was stabilized after 4-9 months. In patients after Burton and Pellegrini operation we achieved an excellent result in 4 cases and in 2 cases a good result. Recovery lasted for 3-6 months. In the female patient after Wulle operation the result is good, stabilized after 4 months.
The authors make a mutual comparison of the results of individual applied procedures. Burton and Pellegrini procedure provides good results which are certainly enhanced by stabilization of base I by MT tendon pulled through the channel. Better results were achieved by using total resection of trapezium. The authors compare the interposition arthroplasty with other surgical procedures which they present in a short overview (arthrodesis, arthroplasty, osteotomy).
Interposition arthroplasty is a suitable solution of osteoarthritis of carpometacarpal joint after the failure of conservative treatment in patients in whom no extreme activity of the affected hand is expected. Burton-Pellegrini procedure is technically more demanding, however, it provides the best results and the fastest recovery. Total resection of trapezium proved efficient as it contributes to a better orientation during operation and to good results.