Purpose
Great effort has been placed on determining the optimal surgical treatment for trapeziometacarpal
joint arthritis (TMA). However, a paucity of literature exists concerning the optimal
timing of surgical intervention. We hypothesized that an increased duration of TMA
symptoms before operative intervention would negatively affect surgical outcomes.
Methods
We performed a retrospective review on 109 adult patients with 121 joints with symptomatic
TMA treated with trapeziectomy and ligament reconstruction with tendon interposition
(LRTI) from 2006 to 2017. Outcome measures included Quick–Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, complication rates, and surgical revision rates.
Results
Among 109 patients, average QuickDASH score at initial presentation was 41.1 ± 17.9. Patients had symptoms of TMA for
an average of 3.2 years (median, 2.1 years) before undergoing operative intervention.
Patients were divided into 2 groups: those with symptoms less than 2 years and those
with symptoms greater than 2 years. Patients who underwent LRTI after less than 2
years of symptoms achieved a significantly greater degree of improvement in the QuickDASH score compared with patients with symptoms greater than 2 years (26.2 vs 5.3).
Conclusions
Patients with less than 2 years of symptomatic TMA before LRTI can expect the greatest
improvement in patient-reported disability impairment compared with those with more
than 2 years of symptoms. This can be used to counsel patients regarding the optimal
timing of surgery if nonsurgical treatment has failed to provide durable symptomatic
relief.
Type of study/level of evidence
Therapeutic IV.
Key words
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Article info
Publication history
Published online: July 31, 2020
Accepted:
May 26,
2020
Received:
May 6,
2019
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2020 by the American Society for Surgery of the Hand. All rights reserved.
