Author(s): M Rab, A Gohritz, T Gohla, H Krimmer, U Lanz
Purpose/Background: This retrospective analysis focused on a comparison of long-term results in patients who underwent resection of the trapezium with subsequent arthroplasty and tendon suspension using either the abductor pollicis longus (APL) or the flexor carpi radialis (FCR) tendon.
Method and Material: Based upon a positive history along with a clinical and radiological examination, 20 patients underwent suspension arthroplasty using the APL tendon (APL group) and 21 patients suspension arthroplasty using the FCR tendon (FCR group) after trapeziectomy. In both groups mean age (APL group: 60.4 ± 5.3; FCR group: 61.7 ± 6.8 years), pain severity according to the Visual Analogue Scale (VAS; APL group: 6.7 ± 1.9; FCR group: 6.9 ± 1.7), severity of arthrosis in the thumb carpometacarpal joint according to the Eaton-Littler classification (APL group: 3 ± 0.7; FCR group: 3.2 ± 0.6) and time interval from onset of symptoms to surgery (APL group: 27 ± 8.1; FCR group: 41.5 ± 14.1 months) did not significantly differ. Each patient of both groups was treated surgically and reviewed by one experienced hand surgeon. Both groups received the same standardized postoperative treatment.
Results: In the APL group the mean operative time was significantly shorter (31.7 ± 9.5 min) than in the FCR group (48.7 ± 7.9 min). The follow-up period from surgery to the final examination was similar in both groups (APL group: 23.1 ± 12.2; FCR group: 31 ± 17.6 months). At the time of the final examinations, no statistically significant differences were found when analyzing the results of the DASH score (APL group: 20.1 ± 15.1; FCR group: 29.3 ± 15.7), the self-administered hand ability score (APL group: 1.7 ± 0.6; FCR group: 2.1 ± 0.6) and the VAS (APL group: 1.1 ± 1.6; FCR group: 0.8 ± 1.5). The time period from surgery to the offset of postoperative pain was also comparable in both groups (APL group: 5 ± 1.8; FCR group: 5.3 ± 2.5 months). The range of abduction in the first carpometacarpal joint after arthroplasty, parallel and perpendicular to the dorsum of the hand, was also similar in both groups (APL group: 63.4 ± 14.3°/62.1 ± 11°; FCR group: 67.8 ± 12.7°/66 ± 12.1°). However, patients enrolled in the APL group revealed significantly better results compared to patients in the FCR group regarding grip-strength, key and pinch grip (APL group: 23.9 ± 9.7/6.6 ± 2.4/6.2 ± 2.8 kg; FCR group: 17 ± 7.2/4.5 ± 1.5/3.6 ± 1.5 kg).
Conclusion: Both techniques led to highly satisfactory results as seen in DASH and VAS data together with a near normal range of abduction in the first carpometacarpal joint in all enrolled patients. However, in direct comparison the APL procedure is technically easier to perform with significantly shorter surgery time recorded and significantly higher values in all force parameters compared to the FCR procedure.Journal of Osteoarthritis