Metacarpophalangeal joint hyperextension in rhizartrosis: is surgical correction necessary?

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Francesco Pogliacomi
Danila Oldani
Paolo Schiavi
Alessio Pedrazzini
Andrea Ferrari
Massimiliano Leigheb
Martina Francesca Pedrini
Enrico Vaienti
Francesco Ceccarelli
Filippo Calderazzi

Keywords

rhizarthrosis, metacarpophalangeal joint hyperextension, trapeziectomy., surgical correction

Abstract

Background and aim: Rhizarthrosis represents 10% of all arthritic manifestations and its prevalence increases with age and in women. The hyperextension of the metacarpophalangeal joint (MCPj) is consequent to a progressive dorsoradial subluxation of the trapeziometacarpal joint (TMj) in advanced osteoarthritis. The aim of this retrospective study is to evaluate the clinical and functional results of 32 patients affected by advanced rhizarthrosis who underwent to modified Burton-Pellegrini’s trapeziectomy in absence of surgical correction of MCPj hyperextension in order to understand when this last step is really necessary. Methods: Patients were assessed trough DASH and PRWHE questionnaires; the functionality of the hand was assessed by carrying out specific test (grip strength, key-pinch, kapandji test, reduction of wrist flexion strength) and the degree of MCP joint hyperextension was recorded. Results: Clinical evaluation and individual satisfactory were positive in most cases (mean DASH 19 and mean PRWHE 21.8, with a reduction of 77% of VAS pain score). Kapandji test was excellent in 26 patients and grip strength and key pinch were stackable in operated and non-operated hands. Twenty-five out 32 patients presented a MCP joint hyperextension between 0° and 5°, 5 of 10° and other 2 of 15°. Conclusion: Modified Burton-Pellegrini’s trapeziectomy is a valid option to treat patient with TMj osteoarthritis. The absence of surgical correction of the MCPj does not affect clinical and functional results in deformities <15°.

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References

1.Dias R, Chandrasenan J, Rajaratnam V, Burke FD. Basal thumb arthritis. Postgraduate Medical Journal 2007; 83(975): 40-3.
2. Armstrong AL, Hunter JB, Davis TR. The prevalence of degenerative arthritis of the base of the thumb in postmenopausal women. J Hand Surg[Br] 1994; 19: 340-1.
3. Lane LB, Eaton RG. Ligament reconstruction for the painful “prearthritic” thumb carpometacarpal joint. Clin. Orthop 1987; 220: 52.
4. Brogan DM, van Hogezand RM, Babovic N, Carlsen B, Kakar S. The Effect of Metacarpophalangeal Joint Hyperextension on Outcomes in the Surgical Treatment of Carpometacarpal Joint Arthritis. J Wrist Surg. 2017 Aug ;6(3): 188-93.
5. Landsmeer JM. The coordination of finger joint motion. J Bone Surg Am 1963; 45: 1654-62.
6. Burton RI, Pellegrini Jr VD. Surgical management of basal Joint arthritis of the thumb. Part II. Ligament reconstruction with tendon interposition arthroplastY. The Journal of Hand Surgery 1986; 11(3): 324-32.
7. Tomaino MM, Pellegrini VD Jr, Burton RI. Arthroplasty of the basal joint of the thumb. Long-term follow-up after ligament reconstruction with tendon interposition. J Bone Joint Surg Am 1995 Mar; 77(3): 346-55.
8. Lins RE, Gelberman, Mckeown L et al. Basal joint arthritis: Trapeziectomy with ligament reconstruction and tendon interposition arthroplasty. J Hand Surg (Am) 1996; 21: 202.
9. Brogan DM, Kakar S. Metacarpophalangeal joint hyperextension and the treatment of thumb basilar joint arthritis. J Hand Surg Am 2012; 37(4): 837-8.
10. Blank J, Feldon P. Thumb metacarpophalangeal joint stabilization during carpometacarpal joint surgery. Atlas Hand Clin 1997; 2: 217–25.
11. Kessler I. A simplified technique to correct hyperextension deformity of the metacarpophalangeal joint of the thumb. J Bone Joint Surg Am 1979; 61(6): 903–5.
12 Van Heest AE, Kallemeier P. Thumb carpal metacarpal arthritis, J Am Acad Orthop Surg 2008 Mar; 16(3): 140-51.
13. Barron OA, Glickel SZ, Eaton RG. Basal joint arthritis of the thumb. J Am. Acad. Orthop Surg 2000 Sep-Oct; 8(5): 314-23.
14. Eaton EG, Glickel SZ. Trapeziometacarpal osteoarthritis: staging in a rationale for treatment. Hand Clin 1987; 3: 455-71.
15. Armbruster EJ, Tan V. Carpometacarpal Joint Disease: Addressing the Metacarpophalangeal Joint Deformity. Hand Clin. 2008 Aug; 24(3): 295-9.
16. Moineau G, Richou J, Liot M, Le Nen D. Prognostic factors for the recovery of hand function following trapeziectomy with ligamentoplasty stabilisation. Orthop Traumatol Surg Res 2009; 95: 352-8.
17. Poulter RJ, Davis TRC. Management of hyperextension of the metacarpophalangeal joint in association with trapeziometacarpal joint osteoarthritis. J Hand Surg 2011; 36B: 280-4.
18. Brogan DM, Kakar S. Metacarpophalangeal joint hyperextension and the treatment of thumb basilar joint arthritis. J Hand Surg Am 2012; 37(4): 837-8.
19. Wajon A, Vinycomb T, Carr E, Edmunds I, Ada L. Surgery for thumb (trapeziometacarpal joint) osteoarthritis. Cochrane Database Syst Rev 2015; 2:CD004631.
20. Vermeulen GM, Slijper H, Feitz R, Hovius SE, Moojen TM, Selles RW. Surgical management of primary thumb carpometacarpal osteoarthritis: a systematic review. J Hand Surg Am 2011; 36(1): 157-69.
21. Pogliacomi F, Oldani D, Schiavi P, Pedrazzini A, Vaienti E, Calderazzi F. Long-term results after modified Burton-Pellegrini's technique in 24 cases affected by advanced rhizarthrosis. Acta Biomed. 2021 Jul 26; 92(S3): e2021005. doi: 10.23750/abm.v92iS3.11578.

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