We have performed arthroligamentoplasty with partial trapeziectomy since 1987. We compare the results of this technique with those of arthroligamentoplasty with total trapeziectomy.
We reviewed 112 arthroligamentoplasties performed by the same surgeon, with a minimum follow-up of three years, comparing partial trapeziectomy (93 hands Eaton stage II-III of the disease and one with post-traumatic osteoarthritis), with total trapeziectomy (nine hands stage IV of the disease, eight hands requiring re-operation due to failure of total trapeziectomy and one with post-traumatic osteoarthritis).
Pain: all the patients have improved. Slight pain at moderate effort persisted in three cases (17%) of total trapeziectomy and in 14 cases (15%) of partial trapeziectomy but only one of these required revision surgery with arthrodesis. Key-Pinch strength: partial trapeziectomy: strength averaged 93% of preoperative strength. In the 34 bilaterally affected cases, the operated hand had 110% of the strength of the non-operated contralateral hand. Total trapeziectomy: strength averaged 85% of preoperative values. In the seven bilateral affection cases, the operated hand had 105% of the strength of the non-operated contralateral hand. Range of motion: we did not register relevant differences. Radiology: in relation to preoperative period, we registered 18% reduction of the scapho-metacarpal space associated with partial trapeziectomy, and 29% in scapho-metacarpal space associated with total trapeziectomy.
we have registered complications in 12 hands.
Both techniques resulted in indistinguishable outcomes. Given the goal of preventing the impairment of a healthy joint and a very hazardous surgical alternative in case of failure, the indication for total trapeziectomy should be restricted to the presence of damage in the two major surfaces of the trapezium.