Thumb trapeziometacarpal joint arthritis: Partial trapeziectomy with ligament reconstruction and interposition costochondral allograft

Qualitative and quantitative outcomes were assessed clinically and radiographically in 41 patients (46 thumbs) with thumb basal joint arthritis limited to the trapeziometacarpal joint treated with hemiresection arthroplasty of the trapezium, flexor carpi radialis ligament reconstruction, and allograft costochondral interposition graft. Results of the validated Disability of Arm, Shoulder, and Hand questionnaire at a mean follow-up time of 42 months (range, 24–48 months) revealed that 90% of the patients had a high level of function with minimal symptoms. Important improvements in web space with increased palmar and radial abduction and grip and pinch strength measurements were observed. The trapeziometacarpal space had decreased 21% after surgery while trapeziometacarpal subluxation was 16% compared with 21% before surgery. There was an inverse correlation between the loss of trapezial height and subluxation and clinical outcome. The results of this study demonstrate that although the preoperative trapezial height was not maintained, the reconstructed thumbs remained stable, with little subluxation and improved clinical outcomes. (J Hand Surg 2000;25A:61–76. Copyright © 2000 by the American Society for Surgery of the Hand.)