The follow-up of trapeziometacarpal arthrodesis using V-shaped osteotomy for osteoarthritis of the first carpometacarpal joint.

Introduction: Osteoarthritis of the trapeziometacarpal joint, also known as the thumb carpometacarpal joint, is one of the most common anatomic sites of arthritis in the human body. Many surgical techniques to address this problem have been developed; including, trapeziectomy with or without ligament reconstruction tendon interposition, implant arthroplasty, and arthrodesis. No methods have yet proven superior to the others, and each has associated limitations and complications. The primary complication found in the literature after arthrodesis of the trapeziometacarpal joint is nonunion; with a reported incidence in the literature as 13% (8% to 39%).

Methods: In 2010, a new surgical technique for this procedure was published by Wolff and Duerinckx in Techniques in Hand Surgery. In summary, a V-shaped osteotomy is made at the base of the first metacarpal and, together with a matching osteotomy of the trapezium, creates a more stable fusion site. Our current research looks at a minimum of 2-year follow-up of patients treated with this technique between 2004 and 2012.

Results: Twenty-one patients, including 3 who had bilateral procedures, have participated in the study. The average age is 62.6 years (range, 51 to 76 y) with an average follow-up of 4.6 years (range, 2 to 8 y). Sixteen are female and 5 are male, with a variety of occupations. In these patients, the Quick DASH score improved 51% (49.8 to 24.2; P=0.0006), and the Quick DASH Work score improved 56% (52.8 to 23.2; P=0.0035). Nineteen of 21 patients said that they wound have the procedure again. Range of motion and strength of the operated versus nonoperated thumbs were compared and showed very similar capabilities. Seventy-five percent (18 of 24) were able to lay their hand flat. There were 4 fibrous unions, resulting in an 83% complete fusion rate. There were no infections or reoperations for nonunion.

Conclusion: The data suggest that this procedure is a highly successful, pain-relieving, strength-preserving, reproducible arthrodesis with a nonunion rate similar to that of the published literature.