Ligament reconstruction and tendon interpositional arthroplasty for degenerative arthritis of the thumb trapeziometacarpal joint.

BACKGROUND: The trapeziometacarpal joint provides important functions for the hand. This joint is often involved in primary osteoarthritis. METHODS: From November 1982 to December 1995, we encountered 42 patients (47 hands) with osteoarthritis (OA). All the patients were Chinese. Thirty-six patients (36 hands) were treated surgically. Ligament reconstruction and tendon interposition arthroplasty were done with total removal of the trapezium or partial removal of trapeziometacarpal joint depending on the stage of the disease. These patients were monitored for an average of 106 months and evaluated both clinically and roentgenographically. RESULTS: Of three stage II cases, the results of two were excellent and one was good. Of the 18 stage III patients, 14 had excellent (77.8%) and four had good (22.2%) results. In the 15 stage IV patients, 10 had excellent (66.6%), four had good (26.7%) and one had fair (6.7%) results. No patient had poor results. CONCLUSIONS: Ligament reconstruction and tendon interpositional arthroplasty is a good alternative in treating degenerative arthritis of the trapeziometacarpal joint of the thumb. Partial removal of the diseased joint is indicated for stage II, and total removal of the trapezium is indicated for stage III and IV patients. Men seek treatment more often than women due to their need to work, even though women are more commonly afflicted with this disorder.