The Journal of Bone and Joint Surgery, Vol 77, Issue 3 346-355, Copyright © 1995 by Journal of Bone and Joint Surgery, Inc
Arthroplasty of the basal joint of the thumb. Long-term follow-up after ligament reconstruction with tendon interposition
MM Tomaino, VD Pellegrini and RI Burton
Department of Orthopaedics, University of Rochester Medical Center, New York.
Twenty-four thumbs of twenty-two patients were evaluated at an average of
nine years (range, eight to eleven years) after a ligament
reconstruction-tendon interposition arthroplasty for osteoarthrosis at the
base of the thumb. The same group had also been examined two and six years
postoperatively. The procedure had been performed as a primary operation in
twenty-one thumbs and as a revision of a failed implant arthroplasty in
three. Twenty-one (95 per cent) of the twenty-two patients had excellent
relief of pain and were satisfied with the outcome. The average grip
strength increased ten kilograms (p < 0.005), reflecting a 93 per cent
improvement compared with the preoperative values. Similarly, the average
tip pinch strength steadily improved, with an increase at the most recent
examination of nearly one kilogram (p < 0.005) (65 per cent
improvement). Improvements in the average key pinch strength, however, were
first noted at the six-year follow-up examination and then tapered
slightly; the most recent values reflected an average gain of 34 per cent
but were not significantly different from the preoperative values. The tip
of twenty-two (92 per cent) of the twenty-four thumbs was able to touch the
base of the little finger, and the most recent average web angle (40
degrees) was unchanged from the value at the two-year follow-up
examination. Stress radiographs showed an average subluxation of the
metacarpal base of 11 per cent at nine years compared with 7 and 8 per cent
at two and six years, respectively. Similarly, these radiographs
demonstrated an average loss of height of the arthroplasty space of 13 per
cent at nine years compared with 11 per cent at both of the earlier
follow-up examinations. This modest deterioration of radiographic
parameters was not predictive of an unsatisfactory outcome. The ligament
reconstruction-tendon interposition arthroplasty provided a stable and
functional reconstruction of the thumb, resulting in excellent relief of
pain and a significant increase in strength for as long as eleven years
after the procedure.
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