Basal joint osteoarthritis of the thumb: ligament reconstruction and tendon interposition versus hematoma distraction arthroplasty

Purpose: Thumb basilar osteoarthritis is common. Several surgical options exist. Studies have evaluated outcomes in separate cohorts but have not compared methods. Our study compared the functional outcome of ligament reconstruction and tendon interposition (LRTI) suspension arthroplasty and hematoma distraction arthroplasty (HDA) by patient questionnaires, clinical measurements, and radiographic measurements to see whether there is validity in exclusively using either LRTI or HDA.

Methods: In this retrospective study, patients received LRTI (12 thumbs in 11 patients) or HDA (9 thumbs in 9 patients) according to the attending surgeon's preference, one exclusively performing LRTI and the other HDA. Patient perception was evaluated with a QuickDASH questionnaire and 10-point pain visual analog scale (VAS). Potential QuickDASH scores range from 0 to 100, with lower scores indicating better function. Clinical evaluation examined grip strength, tip pinch, and lateral pinch in kilograms-force, and range of motion. Measurements were compared with those from the contralateral hand and published normal values. Stressed and unstressed radiographs assessed metacarpal proximal and lateral migration and first web space. Chart review documented surgical times.

Results: The LRTI and HDA scored similarly on QuickDASH. Most reported excellent pain relief. Average grip, tip pinch, and lateral pinch were also similar in both groups. None achieved significance. Comparisons with contralateral hand and published normal results showed that LRTI and HDA were comparable. All except 2 could oppose to little finger base. With stress, additional proximal migration was similar. Web space was preserved with both procedures. LRTI took 54 minutes longer.

Conclusions: The LRTI and HDA were comparable on all levels of objective and subjective measurements. Both groups satisfied the principal goals to provide a stable, mobile, pain-free thumb.

Type of study/level of evidence: Therapeutic III.