Article

Trapeziectomy has been the basis of basal thumb arthritis surgical treatment
since the 1950s. This resection arthroplasty has been continuously refined
(soft-tissue interposition, ligament reconstruction,
spacer implantation, etc.)
without leading to a dramatic outcome improvement. Pain decrease is often
satisfying in the long-term, but comfort during the early postoperative period
may vary. Those disadvantages of trapeziectomy led to the emergence of total
trapeziometacarpal prostheses in the 1970s, with a constant improvement of
implant design. Few series have compared those two surgical techniques side by
side, and prospective ones are even rarer. We compared total trapeziometacarpal
prosthesis and trapeziectomy-interposition in the very short term in two similar
groups of female patients, to determine whether prosthesis led to faster recovery
or not. We compared a total trapeziometacarpal prosthesis (MAIA((R))) and
trapeziectomy-interposition in the immediate and short-term (6 months), for
objective, subjective, functional criteria, as well as short-term comfort or
discomfort. We prospectively followed two comparable cohorts of 47 and 27 female
patients above 50 years of age, treated for basal joint arthritis with a
constrained trapeziometacarpal joint prosthesis or trapeziectomy-interposition,
respectively, between April 2009 and February 2010. The patients were followed
postoperatively for 6 months. Mobility, pain reduction, satisfaction, strength
and functional scores were better in the prosthesis group. The pinch strength
improved by 30%, the length of the thumb column was maintained, and better
correction of the subluxation was obtained in this group. There were six cases of
De Quervain's tenosynovitis and one case of loosening due to trauma. In the
short-term, the MAIA((R)) trapeziometacarpal prosthesis gives better outcome than
trapeziectomy with interposition. This has to be confirmed in the long-term and
after revision surgery that will be likely to occur. CLINICAL RELEVANCE: Therapeuthic 3.
CI - Copyright (c) 2013 Elsevier Masson SAS. All rights reserved.

Langue : FRANCAIS