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Published in: HAND 4/2014

01-12-2014 | Surgery Articles

Long-term follow-up of first metacarpal extension osteotomy for early CMC arthritis

Authors: Franklin H. Chou, James J. Irrgang, Robert J. Goitz

Published in: HAND | Issue 4/2014

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Abstract

Background

The purpose of this study was to evaluate long-term outcomes of first metacarpal extension osteotomy for early trapeziometacarpal arthritis.

Methods

We retrospectively reviewed 13 patients who underwent first metacarpal extension osteotomy at our institution between 1996 and 2005 and obtained subjective and objective outcome data.

Results

Mean follow-up was 9.9 years (range 6 to 14 years). Ten of the 13 patients (77 %) were either satisfied or very satisfied with their results. Mean pain level was 2.00 on a scale of 1 (nonexistent) to 7 (unbearable). Mean QuickDASH score was 24.17, with a median score of 9.09. Mean pinch strength was 13.1 lbs compared to 12.8 lbs in the nonoperative extremity. Mean radial abduction of the thumb was 45.5° which was equal to the nonoperative extremity. Of the eight patients who agreed to repeat radiographs, five had no progression of degenerative changes compared to pre-op radiographs.

Conclusions

Based on subjective and objective follow-up data, first metacarpal extension osteotomy can provide good long-term results in terms of patient satisfaction, pain relief, and upper extremity function. It is a reasonable alternative to ligament reconstruction in patients with early-stage trapeziometacarpal arthritis.
Literature
1.
go back to reference Beaton DE, Wright JG, Katz JN, Upper Extremity Collaborative Group. Development of the QuickDASH: comparison of three item-reduction approaches. J Bone Joint Surg Am. 2005;87(5):1038–46.PubMedCrossRef Beaton DE, Wright JG, Katz JN, Upper Extremity Collaborative Group. Development of the QuickDASH: comparison of three item-reduction approaches. J Bone Joint Surg Am. 2005;87(5):1038–46.PubMedCrossRef
2.
go back to reference Eaton RG, Lane LB, Littler JW, Keyser JJ. Ligament reconstruction for the painful thumb carpometacarpal joint: a long-term assessment. J Hand Surg [Am]. 1984;9(5):692–9.CrossRef Eaton RG, Lane LB, Littler JW, Keyser JJ. Ligament reconstruction for the painful thumb carpometacarpal joint: a long-term assessment. J Hand Surg [Am]. 1984;9(5):692–9.CrossRef
3.
go back to reference Eaton RG, Littler JW. Ligament reconstruction for the painful thumb carpometacarpal joint. J Bone Joint Surg Am. 1973;55(8):1655–66.PubMed Eaton RG, Littler JW. Ligament reconstruction for the painful thumb carpometacarpal joint. J Bone Joint Surg Am. 1973;55(8):1655–66.PubMed
4.
go back to reference Freedman DM, Eaton RG, Glickel SZ. Long-term results of volar ligament reconstruction for symptomatic basal joint laxity. J Hand Surg [Am]. 2000;25(2):297–304.CrossRef Freedman DM, Eaton RG, Glickel SZ. Long-term results of volar ligament reconstruction for symptomatic basal joint laxity. J Hand Surg [Am]. 2000;25(2):297–304.CrossRef
5.
go back to reference Futami T, Nakamura K, Shimajiri I. Osteotomy for trapeziometacarpal arthrosis. 4(1-6) year follow-up of 12 cases. Acta Orthop Scand. 1992;63(4):462–4.PubMedCrossRef Futami T, Nakamura K, Shimajiri I. Osteotomy for trapeziometacarpal arthrosis. 4(1-6) year follow-up of 12 cases. Acta Orthop Scand. 1992;63(4):462–4.PubMedCrossRef
6.
go back to reference Hobby JL, Lyall HA, Meggitt BF. First metacarpal osteotomy for trapeziometacarpal osteoarthritis. J Bone Joint Surg (Br). 1998;80(3):508–12.CrossRef Hobby JL, Lyall HA, Meggitt BF. First metacarpal osteotomy for trapeziometacarpal osteoarthritis. J Bone Joint Surg (Br). 1998;80(3):508–12.CrossRef
7.
go back to reference Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med. 1996;29(6):602–8.PubMedCrossRef Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med. 1996;29(6):602–8.PubMedCrossRef
8.
go back to reference Koff MF, Shrivastava N, Gardner TR, Rosenwasser MP, Mow VC, Strauch RJ. An in vitro analysis of ligament reconstruction or extension osteotomy on trapeziometacarpal joint stability and contact area. J Hand Surg [Am]. 2006;31(3):429–39.CrossRef Koff MF, Shrivastava N, Gardner TR, Rosenwasser MP, Mow VC, Strauch RJ. An in vitro analysis of ligament reconstruction or extension osteotomy on trapeziometacarpal joint stability and contact area. J Hand Surg [Am]. 2006;31(3):429–39.CrossRef
9.
go back to reference Macey AC, Burke FD, Abbott K, Barton NJ, Bradbury E, Bradley A, et al. Outcomes of hand surgery. British Society for Surgery of the Hand. J Hand Surg (Br). 1995;20(6):841–55.CrossRef Macey AC, Burke FD, Abbott K, Barton NJ, Bradbury E, Bradley A, et al. Outcomes of hand surgery. British Society for Surgery of the Hand. J Hand Surg (Br). 1995;20(6):841–55.CrossRef
10.
go back to reference Molitor PJ, Emery RJ, Meggitt BF. First metacarpal osteotomy for carpometacarpal osteoarthritis. J Hand Surg (Br). 1991;16(4):424–7.CrossRef Molitor PJ, Emery RJ, Meggitt BF. First metacarpal osteotomy for carpometacarpal osteoarthritis. J Hand Surg (Br). 1991;16(4):424–7.CrossRef
11.
go back to reference Parker WL, Linscheid RL, Amadio PC. Long-term outcomes of first metacarpal extension osteotomy in the treatment of carpal-metacarpal osteoarthritis. J Hand Surg [Am]. 2008;33(10):1737–43.CrossRef Parker WL, Linscheid RL, Amadio PC. Long-term outcomes of first metacarpal extension osteotomy in the treatment of carpal-metacarpal osteoarthritis. J Hand Surg [Am]. 2008;33(10):1737–43.CrossRef
12.
go back to reference Pellegrini Jr VD. Osteoarthritis of the trapeziometacarpal joint: the pathophysiology of articular cartilage degeneration. I. Anatomy and pathology of the aging joint. J Hand Surg [Am]. 1991;16(6):967–74.CrossRef Pellegrini Jr VD. Osteoarthritis of the trapeziometacarpal joint: the pathophysiology of articular cartilage degeneration. I. Anatomy and pathology of the aging joint. J Hand Surg [Am]. 1991;16(6):967–74.CrossRef
13.
go back to reference Pellegrini Jr VD. Osteoarthritis of the trapeziometacarpal joint: the pathophysiology of articular cartilage degeneration. II. Articular wear patterns in the osteoarthritic joint. J Hand Surg [Am]. 1991;16(6):975–82.CrossRef Pellegrini Jr VD. Osteoarthritis of the trapeziometacarpal joint: the pathophysiology of articular cartilage degeneration. II. Articular wear patterns in the osteoarthritic joint. J Hand Surg [Am]. 1991;16(6):975–82.CrossRef
14.
go back to reference Pellegrini Jr VD, Olcott CW, Hollenberg G. Contact patterns in the trapeziometacarpal joint: the role of the palmar beak ligament. J Hand Surg [Am]. 1993;18(2):238–44.CrossRef Pellegrini Jr VD, Olcott CW, Hollenberg G. Contact patterns in the trapeziometacarpal joint: the role of the palmar beak ligament. J Hand Surg [Am]. 1993;18(2):238–44.CrossRef
15.
go back to reference Pellegrini Jr VD, Parentis M, Judkins A, Olmstead J, Olcott C. Extension metacarpal osteotomy in the treatment of trapeziometacarpal osteoarthritis: a biomechanical study. J Hand Surg [Am]. 1996;21(1):16–23.CrossRef Pellegrini Jr VD, Parentis M, Judkins A, Olmstead J, Olcott C. Extension metacarpal osteotomy in the treatment of trapeziometacarpal osteoarthritis: a biomechanical study. J Hand Surg [Am]. 1996;21(1):16–23.CrossRef
16.
go back to reference Pellegrini Jr VD, Smith RL, Ku CW. Pathobiology of articular cartilage in trapeziometacarpal osteoarthritis. I. Regional biochemical analysis. J Hand Surg [Am]. 1994;19(1):70–8.CrossRef Pellegrini Jr VD, Smith RL, Ku CW. Pathobiology of articular cartilage in trapeziometacarpal osteoarthritis. I. Regional biochemical analysis. J Hand Surg [Am]. 1994;19(1):70–8.CrossRef
17.
go back to reference Shrivastava N, Koff MF, Abbot AE, Mow VC, Rosenwasser MP, Strauch RJ. Simulated extension osteotomy of the thumb metacarpal reduces carpometacarpal joint laxity in lateral pinch. J Hand Surg [Am]. 2003;28(5):733–8.CrossRef Shrivastava N, Koff MF, Abbot AE, Mow VC, Rosenwasser MP, Strauch RJ. Simulated extension osteotomy of the thumb metacarpal reduces carpometacarpal joint laxity in lateral pinch. J Hand Surg [Am]. 2003;28(5):733–8.CrossRef
18.
go back to reference Tomaino MM. Treatment of Eaton stage I trapeziometacarpal disease with thumb metacarpal extension osteotomy. J Hand Surg [Am]. 2000;25(6):1100–6.CrossRef Tomaino MM. Treatment of Eaton stage I trapeziometacarpal disease with thumb metacarpal extension osteotomy. J Hand Surg [Am]. 2000;25(6):1100–6.CrossRef
19.
go back to reference Tomaino MM, King J, Leit M. Thumb basal joint arthritis. In: Green DP, Hotchkiss RN, Pederson WC, Wolfe SW, editors. Green’s operative hand surgery. 5th ed. Philadelphia, PA: Elsevier; 2005. p. 461. Tomaino MM, King J, Leit M. Thumb basal joint arthritis. In: Green DP, Hotchkiss RN, Pederson WC, Wolfe SW, editors. Green’s operative hand surgery. 5th ed. Philadelphia, PA: Elsevier; 2005. p. 461.
20.
go back to reference Wilson JN. Basal osteotomy of the first metacarpal in the treatment of arthritis of the carpometacarpal joint of the thumb. Br J Surg. 1973;60(11):854–8.PubMedCrossRef Wilson JN. Basal osteotomy of the first metacarpal in the treatment of arthritis of the carpometacarpal joint of the thumb. Br J Surg. 1973;60(11):854–8.PubMedCrossRef
21.
go back to reference Wilson JN, Bossley CJ. Osteotomy in the treatment of osteoarthritis of the first carpometacarpal joint. J Bone Joint Surg (Br). 1983;65(2):179–81. Wilson JN, Bossley CJ. Osteotomy in the treatment of osteoarthritis of the first carpometacarpal joint. J Bone Joint Surg (Br). 1983;65(2):179–81.
Metadata
Title
Long-term follow-up of first metacarpal extension osteotomy for early CMC arthritis
Authors
Franklin H. Chou
James J. Irrgang
Robert J. Goitz
Publication date
01-12-2014
Publisher
Springer US
Published in
HAND / Issue 4/2014
Print ISSN: 1558-9447
Electronic ISSN: 1558-9455
DOI
https://doi.org/10.1007/s11552-014-9632-z

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