Long-Term Outcomes in Female Patients With Carpometacarpal Arthroplasty and Metacarpophalangeal Fusion Compared With the Unoperated Side or Carpometacarpal Arthroplasty.

ABSTRACT

PURPOSE: Patients with carpometacarpal (CMC) osteoarthritis (OA) often present with metacarpophalangeal (MP) hyperextension and/or thenar atrophy. This study hypothesizes that MP fusion (MPF) performed at the time of CMC arthroplasty (CMCA) for patients who have moderate-to-severe thenar atrophy, MP hyperextension >30°, or MP arthritis will have greater long-term pinch strength and improvements in the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score from preoperative values when compared with the unoperated side or those who had CMCA only. METHODS: This study involved a retrospective review of long-term results from patients who underwent either CMCA or CMCA/MPF. The QuickDASH score, the pain visual analog scale (VAS), and an average of three pinch readings from each thumb were measured on the Baseline pinch gauge and recorded with a correction for hand dominance in right-handed patients. RESULTS: Fifty-three female patients with 70 operated thumbs were included in the study. The mean age was 67.2 years. There were 29 CMCAs and 41CMCA/MPFs. The mean follow-up was 6.3 years (range 2-16.9 years). At the latest follow-up, the mean CMCA/MPF pinch strength (11.3 lbs) was significantly stronger than that of CMCA (8.0 lbs) and carpometacarpal osteoarthritis thumbs (8.9 lbs). There was no significant difference in pinch strength between patients who underwent a CMCA and CMCOA thumbs (8.0 lbs vs 8.9 lbs, respectively). Preoperative QuickDASH demonstrated worse function in the CMCA/MPF group (55.8 vs 36.5). At the latest follow-up, QuickDASH and VAS revealed similar values in both the CMCA/MPF (10.5 and 0.66) and CMCA (18.5 and 0.52) groups. CONCLUSION: Long-term results demonstrate stronger pinch and greater improvement in QuickDASH scores in patients who underwent CMCA/MPF compared with those who underwent a CMCA or untreated carpometacarpal osteoarthritis thumbs. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.