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Metacarpal Subsidence following Thumb Carpometacarpal Joint Arthroplasty
Jignesh Unadkat MD, John Fowler MD, Joseph Imbriglia MD
University of Pittsburgh Medical Center
2015-03-15
Presenter: Jignesh V Unadkat
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. Jignesh has conducted this original research during his hand rotation.
Director Name: Joseph Losee
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Hand
Background: Thumb Carpometacarpal (CMC) arthritis causes significant disability. When conservative measures have failed, various surgical options exist. Post-surgical metacarpal subsidence may lead to pain due to abutment on distal scaphoid, leading to a weaker thumb. The purpose of this study was to compare the amount of metacarpal subsidence between ligament reconstruction tendon interposition (LRTI) and simple trapeziectomy with tendon interposition (TI).
Methods: An IRB approved, retrospective chart review of patients undergoing CMC arthroplasty from 2010-2013 was performed. Surgical technique (LRTI or TI) was performed at the surgeon's discretion. All patients undergoing CMC arthroplasty who had hand radiographs pre-operatively, 2 weeks, 3 months and >6 months post-operatively were included. Metacarpal subsidence was calculated as post-operative trapezial space ratio (distance from thumb metacarpal base to scaphoid / proximal phalanx length) compared to pre-operative evaluation.
Results: 86 patients underwent CMC arthroplasty; 29 patients (31 thumbs) matched our inclusion criteria. Average age was 60 years (range 46-81 years). Long-term follow up averaged 13 months (range 6 – 35 months). 2 weeks post-operatively there was 50% metacarpal subsidence that remained constant even at long-term follow-up. Eaton grade, gender, thumb laterality or type of operation were not significantly associated with >50% subsidence. Controlling for type of operation age >60yrs was most associated with >50% subsidence [OR 11.0652 (1.0856 – 112.7827)].
Conclusion: Surgical technique does not affect outcomes or subsidence after CMC arthroplasty. Age >60yrs is significant independent predictor of >50%subsidence, irrespective of technique. In carefully selected patients, performing the shorter, less complex operation may result in equivalent outcomes.
