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Combined Treatment of Trapeziometacarpal Joint Arthritis and SLAC Wrist
Grzegorz Kwiecien MD, Mark Hendrickson MD, William Seitz MD, Peter Evans MD, Antonio Rampazzo MD PhD, Bahar Bassiri Gharb MD PhD
Cleveland Clinic
2019-02-15
Presenter: Grzegorz Kwiecien
Affidavit:
The above referenced material represents original work of the resident
Director Name: Steven Bernard
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Hand
INTRODUCTION
Combined treatment of trapeziometacarpal osteoarthritis (OA) and SLAC wrist presents unique challenges. The consequences of loss of radial column support caused by scaphoidectomy and trapeziectomy are not well known. We hypothesized that simultaneous treatment of the trapeziometacarpal OA and SLAC wrist will result in an increased complication rate when compared to staged treatment.
METHODS
An IRB approved retrospective review of patients who underwent surgery for both trapeziometacarpal OA and SLAC wrist between 2003 and 2017 at the Cleveland Clinic Health System.
RESULTS
A total of 1638 patients treated for wrist arthritis were identified. Twenty-two patients who underwent both trapeziectomy with LRTI and one of the three procedures for SLAC wrist (four-corner fusion (N=10), proximal row carpectomy (N=7), and wrist replacement (N=5)) in a single stage (N=10) or two-stage (N=12) were included. Mean follow-up was 46.3months. The overall VAS score for pain at rest and activity showed significant improvement after both procedures (Ä-2.1 and Ä-5.8, respectively; p<0.05). Quick DASH and AM-PAC scores showed significant improvement (p<0.01) and were comparable to patients undergoing staged treatment (p>0.05). There were no significant differences in ROM between patients undergoing partial versus complete scaphoidectomy. However, patients with preserved distal scaphoid had significantly higher grip and pinch strengths (p<0.05).
CONCLUSION
Trapeziometacarpal OA and SLAC wrist may be treated either simultaneously or staged. Trapeziectomy and LRTI with the preservation of the distal pole of scaphoid results in better grip and pinch strength. Partial preservation of the scaphoid should be considered when planning for subsequent trapezium resection.
