Trapeziectomy, Partial Trapezoidectomy, and Abductor Pollicis Longus Dual Loop Ligament Reconstruction for Advanced Basal Joint Arthritis: Long-Term Outcome of 150 Cases

Background: Although hand surgeons usually concur that arthroplasty is indicated for disabling basal joint arthritis, controversy persists regarding the preferred surgical methods. This article describes a novel technique of trapezial excisional arthroplasty with partial trapezoidectomy and abductor pollicis longus (APL) dual ligament reconstruction, and reports the long-term results of 150 cases. Based on this experience, we hypothesize that this technique is a reliably effective and durable surgical option for basal joint arthritis. Methods: This study evaluated consecutive patients with Eaton and Littler advanced stage III/IV basal joint arthritis, treated by this procedure, and followed for a minimum of 10 years. Outcome assessment included grip and pinch strength, thumb mobility, radiographic parameters, pain relief, and patient-reported outcomes as measured with the Disabilities of the Arm, Shoulder, and Hand (DASH) scoring system. Results: A total of 150 thumbs in 124 patients with an average follow-up of 13.5 years (range, 10-22 years) were studied. Alleviation of pain and patient satisfaction were constant outcomes, and the mean DASH score was a normative 8.7. Grip and pinch strength were significantly improved (P <.001), carpometacarpal joint malalignment and adduction deformities were consistently corrected, complications were few, and revision surgery was unnecessary. Conclusions: These results support the premise that trapeziectomy and partial trapezoidectomy with APL dual ligament stabilization is a reliable and durable arthroplasty for basal joint arthritis with distinct advantages and equally favorable outcomes when compared with other frequently employed methods.