Trapeziometacarpal osteoarthritis is a prevalent degenerative condition affecting the hands. While trapezium excision has shown satisfactory outcomes, the potential subsidence of the thumb metacarpal, which could compromise strength, remains a significant concern. To address these issues, various modified procedures, such as ligament reconstruction and suspension arthroplasty, have been developed. We devised a modified technique that includes partial trapezium excision, ligament reconstruction using half of the flexor carpi radialis tendon and anchoring onto the 2nd metacarpal base, and tendon interposition. We then compared the subsidence resulting from this technique with that observed in other surgical treatments.
We retrospectively reviewed the radiographs of patients who underwent surgical treatment for trapeziometacarpal osteoarthritis between August 2019 and April 2024. A total of 10 patients were treated with the modified technique, while 7 patients underwent suspension arthroplasty using a tightrope. We measured the gaps between the base of the 1st metacarpal and the scaphoid, as well as the lengths of the capitate, which served as references. The ratios between the gap and the capitate length were calculated, and the results from the modified technique were compared with those from the suspension arthroplasty.
In patients who underwent the modified technique, the average ratio between the gap and the capitate length was 0.32 ± 0.07. In comparison, the suspension arthroplasty group had an average ratio of 0.36 ± 0.05 (p-value = 0.18). The difference in subsidence between these two groups was not statistically significant.
The modified surgical technique, including partial excision of the trapezium and anchoring the FCR tendon to the 2nd metacarpal base, yielded results comparable to those of the conventional method, and it may prevent subsidence of the thumb metacarpal.
