Total joint arthroplasty versus resection-interposition arthroplasty for thumb carpometacarpal arthritis: a randomized controlled trial

Authors

  • Sebastian M Klim Department for Orthopaedics and Trauma, Medical University of Graz, Graz https://orcid.org/0000-0002-4476-8682
  • Reingard Glehr Institute of General Practice and Evidencebased Health Services Research, Medical University of Graz, Austria
  • Armin Graef Department for Orthopaedics and Trauma, Medical University of Graz, Graz
  • Florian Amerstorfer Department for Orthopaedics and Trauma, Medical University of Graz, Graz
  • Andreas Leithner Department for Orthopaedics and Trauma, Medical University of Graz, Graz https://orcid.org/0000-0002-2598-2325
  • Mathias Glehr Department for Orthopaedics and Trauma, Medical University of Graz, Graz

DOI:

https://doi.org/10.2340/17453674.2023.11919

Keywords:

Arthroplasty, Articular cartilage, Implants, Osteoarthrosis, RCT

Abstract

Background and purpose: Thumb carpometacarpal (TCMC) osteoarthritis is a common condition that causes pain and functional limitations. We compared the outcomes of 2 surgical procedures for TCMC osteoarthritis, the Epping resection-suspension arthroplasty and the double-mobility TCMC prosthesis, and focused on pain relief, functional outcomes, and patient quality of life.
Patients and methods: Over a 7-year period a randomized controlled trial including 183 cases of TCMC osteoarthritis was conducted comparing a double mobility TCMC prosthesis (Moovis, Stryker, Kalamazoo, MI, USA) with the Epping resection-suspension arthroplasty. Pre- and postoperative examinations included the range of motion (ROM), SFMcGill score, visual analogue scale (VAS), the disabilities of the arm, shoulder and hand questionnaire (DASH), and the hospital anxiety and depression scale (HADS).
Results: At the 6-week postoperative follow-up, significant differences were found in VAS: Epping median 4.0 (interquartile range [IQR] 2.0–5.0) vs. TCMC prosthesis 2.0 (IQR 0.25–4.0), p = 0.03, effect size (area under the curve [AUC]) 0.64 (95% confidence interval [CI] 0.55–0.73), in DASH score: Epping 61 (IQR 43–75) vs. TCMC prosthesis 45 (IQR 29–57), p < 0.001, AUC 0.69 (CI 0.61– 0.78), and in radial abduction: Epping 55 (IQR 50–60) vs. TCMC prosthesis 62 (IQR 60–70), p = 0.001, AUC 0.70 (CI 0.61–0.79). No significant group differences were found at the 6- and 12-months follow-up. During the follow-up period, 3 of 82 prostheses had to be revised but there was no revision in the Epping group.
Conclusion: The double mobility TCMC prosthesis had superior outcomes compared with the Epping procedure at 6 weeks; however, there were no significant differences in outcomes at 6 months and 1 year postoperatively. The implant survival rate of 96% after 12 months was acceptable

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Additional Files

Published

2023-05-03

How to Cite

Klim, S. M., Glehr, R., Graef, A., Amerstorfer, F., Leithner, A., & Glehr, M. (2023). Total joint arthroplasty versus resection-interposition arthroplasty for thumb carpometacarpal arthritis: a randomized controlled trial. Acta Orthopaedica, 94, 224–229. https://doi.org/10.2340/17453674.2023.11919

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