Surgical Rhizarthrosis Treatment: Trapezius Resection Arthroplasty Associated with Tendon Interposition versus the Kuhns Technique.

Objective This study aimed to evaluate and compare the clinical and functional outcomes of two surgical procedures performed in patients with severe grade III and IV rhizarthrosis. Methods We evaluated 39 patients who underwent two surgical techniques for rhizarthrosis treatment: trapeziectomy using the Kuhns technique or tendon interposition, with a minimum follow-up period of 6 months. The primary outcome assessment used the specific Trapeziometacarpal Arthrosis Symptoms and Disability (TASD) questionnaire, and the secondary outcome evaluation employed the shortened version of the Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire and the visual analog scale (VAS). Results There was no statistically significant difference between groups in the TASD, QuickDASH, and VAS results, and both techniques demonstrated good functional and pain outcomes. No complication required a new surgical approach. We found a positive correlation between TASD and QuickDASH questionnaire scores, suggesting their effectiveness in assessing functionality and disability in subjects with rhizarthrosis. Conclusion Trapeziectomy using the Kuhns technique and tendon interposition proved effective in the surgical treatment of rhizarthrosis. There was no significant difference between the techniques concerning functional outcomes.

Surgical Rhizarthrosis Treatment: Trapezius Resection Arthroplasty Associated with Tendon Interposition versus the Kuhns Technique / Tratamento cirúrgico da rizartrose: Artroplastia de ressecção do trapézio associada a interposição tendínea versus técnica de Kuhns

Abstract Objective This study aimed to evaluate and compare the clinical and functional outcomes of two surgical procedures performed in patients with severe grade III and IV rhizarthrosis. Methods We evaluated 39 patients who underwent two surgical techniques for rhizarthrosis treatment: trapeziectomy using the Kuhns technique or tendon interposition, with a minimum follow-up period of 6 months. The primary outcome assessment used the specific Trapeziometacarpal Arthrosis Symptoms and Disability (TASD) questionnaire, and the secondary outcome evaluation employed the shortened version of the Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire and the visual analog scale (VAS). Results There was no statistically significant difference between groups in the TASD, QuickDASH, and VAS results, and both techniques demonstrated good functional and pain outcomes. No complication required a new surgical approach. We found a positive correlation between TASD and QuickDASH questionnaire scores, suggesting their effectiveness in assessing functionality and disability in subjects with rhizarthrosis. Conclusion Trapeziectomy using the Kuhns technique and tendon interposition proved effective in the surgical treatment of rhizarthrosis. There was no significant difference between the techniques concerning functional outcomes.

Resumo Objetivo O objetivo deste estudo é avaliar e comparar os resultados clínicos e funcionais de dois procedimentos cirúrgicos realizados em pacientes com rizartrose grave graus III e IV. Métodos Avaliamos 39 pacientes submetidos a 2 técnicas cirúrgicas para o tratamento da rizartrose: trapeziectomia pela técnica de Kuhns ou com interposição tendínea, com mínimo de 6 meses de seguimento. O desfecho primário foi avaliado pelo questionário específico Sintomas e Incapacidade da Artrose Trapeziometacarpiana (Trapeziometacarpal Arthrosis Symptoms and Disability, TASD, em inglês), e os desfechos secundários, pela versão abreviada do Questionário de Incapacidades do Braço, Ombro e Mão (Disabilities of the Arm, Shoulder, and Hand, QuickDASH, em inglês) e a Escala Visual Analógica (EVA). Resultados Não houve diferença estatisticamente significantiva entre os grupos nos resultados do TASD, QuickDASH e EVA e ambas as técnicas demonstraram bons resultados funcionais e da dor. Não houve complicações que necessitassem de nova abordagem cirúrgica. Verificamos uma correlação positiva entre as pontuações no TASD e no QuickDASH, o que sugere que ambos são eficazes na avaliação da funcionalidade e incapacidade da rizartrose. Conclusão A trapeziectomia com técnica de Kuhns e com interposição tendínea se mostraram efetivas no tratamento cirúrgico da rizartrose. Não houve diferença significativa entre as técnicas em relação aos resultados funcionais.

Measurement of quality of life among patient undergoing arthroplasty of the thumb to treat CMC arthritis.

OBJECTIVE: To present the clinical and functional results, including measurement of quality of life, of patients undergoing trapeziometacarpal arthroplasty. METHOD: This was a prospective evaluation on 45 patients (53 thumbs) with a diagnosis of idiopathic rhizarthrosis who underwent resection arthroplasty and interposition of an uncemented Ascension(®) implant, made of pyrocarbon. The clinical and functional results were analyzed through radiography, range of motion (ROM) in degrees (°), visual analog scale (VAS) for pain and the disability of arm, shoulder and hand (DASH) questionnaire for quality of life. In the group analyzed, 38 were women and seven were men, and their mean age was 63.17 years (range: 50-78). Eight patients were treated bilaterally. RESULTS: After 42.08 months of follow-up (range: 8-73), the subjective pain evaluation (VAS) score was 1.37 (range: 1-4). The complete ROM of the thumb increased to 95.75% (range: 75-100%) in relation to the contralateral side. The mean DASH questionnaire score was 9.98 (range: 1-18). The complication rate (negative events) was 11.32%. Five patients presented dislocation of the thumb prosthesis. All of them were reoperated by means of dorsal capsuloplasty using a portion of the retinaculum of the extensors as a graft, and good clinical evolution was achieved in these cases. One patient presented fracturing of the metacarpal and was treated by means of osteosynthesis using Kirschner wires. CONCLUSION: This method is effective for treating rhizarthrosis, according to the measurements made on the clinical and functional results, even after taking the complication rate into consideration. Moreover, it provides an improvement of quality of life for these patients.

OBJETIVO: Apresentar os resultados clínico-funcionais e a mensuração da qualidade de vida dos pacientes submetidos à artroplastia trapézio-metacárpica. MÉTODO: Avaliação prospectiva de 45 pacientes e 53 polegares acometidos, com diagnóstico de rizartrose idiopática submetidos à artroplastia de ressecção e interposição, com o implante Ascension®, não cimentado, de pirocarbono. Foram analisados os resultados clínico-funcionais: análise radiográfica, o arco de movimento (ADM) em graus (°), dor (VAS: visual analog score), qualidade de vida (Dash: disability shoulder, arm, and hand questionnaire). No grupo analisado, 38 são mulheres e sete são homens e a idade média é de 63,17 anos (50-78). Foram operados oito pacientes com acometimento bilateral dos polegares. RESULTADOS: Após 42,08 meses (8-73) de seguimento, a avaliação subjetiva da dor (VAS) foi de 1,37 (1-4). O arco do movimento completo do polegar teve um aumento de 95,75% (75-100) do lado contralateral. O questionário Dash foi em média de 9,98 (1-18). A taxa de complicações ou eventos negativos foi de 11,32%. Observamos cinco pacientes com luxações das próteses de polegares. Todos foram reoperados e fez-se a capsuloplastia dorsal, com o uso como enxerto de uma porção da retinácula dos extensores, obteve-se uma boa evolução clínica nesses casos. Um paciente apresentou fratura do metacarpo e foi tratado com osteossíntese com fio de Kirschner. CONCLUSÃO: O método é eficaz no tratamento da rizartrose de acordo com os valores apurados dos resultados clínico-funcionais, mesmo considerando-se as taxas de complicações. Além disso, proporciona a melhoria da qualidade de vida desses pacientes.

Measurement of quality of life among patient undergoing arthroplasty of the thumb to treat CMC arthritis / Mensuração da qualidade de vida dos pacientes submetidos a artroplastia do polegar no tratamento da rizartrose

ABSTRACT OBJECTIVE: To present the clinical and functional results, including measurement of quality of life, of patients undergoing trapeziometacarpal arthroplasty. METHOD: This was a prospective evaluation on 45 patients (53 thumbs) with a diagnosis of idiopathic rhizarthrosis who underwent resection arthroplasty and interposition of an uncemented Ascension(r) implant, made of pyrocarbon. The clinical and functional results were analyzed through radiography, range of motion (ROM) in degrees (°), visual analog scale (VAS) for pain and the disability of arm, shoulder and hand (DASH) questionnaire for quality of life. In the group analyzed, 38 were women and seven were men, and their mean age was 63.17 years (range: 50-78). Eight patients were treated bilaterally. RESULTS: After 42.08 months of follow-up (range: 8-73), the subjective pain evaluation (VAS) score was 1.37 (range: 1-4). The complete ROM of the thumb increased to 95.75% (range: 75-100%) in relation to the contralateral side. The mean DASH questionnaire score was 9.98 (range: 1-18). The complication rate (negative events) was 11.32%. Five patients presented dislocation of the thumb prosthesis. All of them were reoperated by means of dorsal capsuloplasty using a portion of the retinaculum of the extensors as a graft, and good clinical evolution was achieved in these cases. One patient presented fracturing of the metacarpal and was treated by means of osteosynthesis using Kirschner wires. CONCLUSION: This method is effective for treating rhizarthrosis, according to the measurements made on the clinical and functional results, even after taking the complication rate into consideration. Moreover, it provides an improvement of quality of life for these patients.

RESUMO OBJETIVO: Apresentar os resultados clínico-funcionais e a mensuração da qualidade de vida dos pacientes submetidos à artroplastia trapézio-metacárpica. MÉTODO: Avaliação prospectiva de 45 pacientes e 53 polegares acometidos, com diagnóstico de rizartrose idiopática submetidos à artroplastia de ressecção e interposição, com o implante Ascension(r), não cimentado, de pirocarbono. Foram analisados os resultados clínico-funcionais: análise radiográfica, o arco de movimento (ADM) em graus (°), dor (VAS: visual analogue score), qualidade de vida (Dash: disability shoulder, arm, and hand questionnaire). No grupo analisado, 38 são mulheres e sete são homens e a idade média é de 63,17 anos (50-78). Foram operados oito pacientes com acometimento bilateral dos polegares. RESULTADOS: Após 42,08 meses (8-73) de seguimento, a avaliação subjetiva da dor (VAS) foi de 1,37 (1-4). O arco do movimento completo do polegar teve um aumento de 95,75% (75-100) do lado contralateral. O questionário Dash foi em média de 9,98 (1-18). A taxa de complicações ou eventos negativos foi de 11,32%. Observamos cinco pacientes com luxações das próteses de polegares. Todos foram reoperados e fez-se a capsuloplastia dorsal, com o uso como enxerto de uma porção da retinácula dos extensores, obteve-se uma boa evolução clínica nesses casos. Um paciente apresentou fratura do metacarpo e foi tratado com osteossíntese com fio de Kirschner. CONCLUSÃO: O método é eficaz no tratamento da rizartrose de acordo com os valores apurados dos resultados clínico-funcionais, mesmo considerando-se as taxas de complicações. Além disso, proporciona a melhoria da qualidade de vida desses pacientes.

Artrosis de la articulación trapecio-metacarpiana. Tratamientoquirúrgico con resección del trapecio y reconstruccióncon tendosuspensión del abductor pollicis longus / Trapeziometacarpal joint osteoarthritis. Surgical treatment with resection of the trapezium and suspension arthroplasty reconstruction with the abductor pollicis longus

La artrosis trapecio-metacarpiana es causa de dolor en el pulgar alrededor de la quintadécada, con prevalencia del 25%. El ligamento oblicuo anterior profundo, el intermetacarpiano, el dorsal y el radial juegan un papel importante para la estabilidad de laarticulación.Materiales y métodos: Se muestran los resultados de la resección del trapecio y ligamentoplastiadel abductor pollicis longus.Es una serie de casos operados con 2 técnicas, un grupo con resección del trapecio mástendosuspensión del pollicis longus (técnica descrita por Brunelli) y otro grupo con reseccióndel trapecio y tendosuspensión entre pollicis longus y el flexor carpi radialis.Resultados: Fueron operadas 21  manos en cada grupo, con seguimiento mínimo de12  meses. Se evaluó el dolor, la movilidad y la satisfacción del paciente. Los resultadosfueron similares en ambos grupos, con disminución del dolor (escala visual análoga) deentre 8 y 9 a menos de 1, con buena movilidad y todos satisfechos con el resultado.Discusión: Muchos estudios muestran que no hay diferencias entre la resección del trapecioúnica o combinada con reconstrucción ligamentosa o interposición tendinosa. El espaciotrapezoidal disminuye casi igual en todos los grupos y no se correlaciona con la fuerza delpulgar.En este estudio se lograron buenos resultados en ambos grupos y similares a un grupoprevio tratado con Artelon, en cuanto a disminución de dolor y movilidad.Estos resultados soportan el pensamiento de que cualquier técnica usada brinda buenosresultados, para lo cual recomendamos utilizar la más simple de acuerdo con las necesidadesdel paciente...

Trapeziometacarpal joint osteoarthritis causes pain in the thumb, usually around the fifth decade, and with a prevalence of 25%. The deep anterior oblique ligament, the intermetacarpal ligament and the dorso-radial ligament play an important role in the stability of the joint.Materials and methods: The results with resection of the trapezium and ligamentoplasty with abductor pollicis longus (APL) are presented in a series of cases.Two techniques were used, with one group with resection of the trapezium plus suspension arthroplasty with the APL (technique described by Brunelli), and another group with resection of the trapezium and a new suspension arthroplasty with the APL with the flexor carpi radialis.Results: A total of 21 hands were operated on in each group, with minimum follow-up of 12 months. Pain, mobility and satisfaction were evaluated. The results were similar in both groups, with decreased pain (EVA) from between 8 and 9 to less than 1, with good mobility, and all the patients were satisfied with the results.Discussion: Different studies show that there are no differences between resection only of the trapezium or combined with ligament reconstruction and / or tendon interposition. The trapezoidal space decrease is almost equal in all groups, and did not correlate with the strength of the thumb.In this study, good results were achieved in both groups in terms of the reduction in pain and mobility, and similar to an earlier group treated with Artelon. These results support the hypothesis that either technique provides good results, thus we recommend using the simplest according to patient needs...

ARTHROPLASTY FOR TRAPEZIUM EXCISION AND TENDON INTERPOSITION IN RHIZARTHROSIS CASES: PROSPECTIVE STUDY.

OBJECTIVE: To prospectively evaluate the results from a series of patients who underwent surgical treatment for rhizarthrosis using the technique of trapezium resection associated with interposition of yarn from the long abductor tendon of the thumb. METHODS: From May to August 2005, ten patients underwent surgical treatment for rhizarthrosis. Patients with primary osteoarthrosis of the trapezium-metacarpal joint, in stages II, III and IV of the Eaton classification, with persistent pain that was refractory to clinical treatment, were included. For the functional assessment, the visual analogue scale, DASH questionnaire and Buck-Gramcko score were used. For the overall assessment on the patients, strength measurements were made for palm grip, pulp to pulp pinch, lateral pinch, three-point pinch, opposition and radial and palmar abductions. The migration index for the first metacarpal was also determined on radiographs at rest and under stress. RESULTS: The pain relief was considered to be good (p = 0.005), with functional improvements in modules 2 (p = 0.02) and 3 (p = 0.022) of DASH. The Buck-Gramcko score showed one excellent and three very good results. There was an improvement in almost all of the overall assessment and was only non-significant regarding lateral pinch and abduction. For all patients, there was migration of the first metacarpal. CONCLUSION: Trapeziectomy associated with interposition of yarn from the long abductor tendon of the thumb was shown to be a relatively simple and effective technique for pain relief and functional improvement.

SURGICAL TREATMENT OF RHIZARTHROSIS: TRAPEZIECTOMY WITH OR WITHOUT LIGAMENTOPLASTY VERSUS TOTAL PROSTHESIS.

OBJECTIVE: The aim of this study was to review cases that underwent surgical treatment using two techniques: trapeziectomy with or without ligamentoplasty and arthroplasty with implant. METHODS: Fifty-two hands that were surgically treated for rhizarthrosis between 1995 and 2008 were evaluated: 32 cases of trapeziectomy with or without ligamentoplasty (group A) and 20 with implant arthroplasty (group B). The mean follow-up for group A was 72 months and for group B, 23 months. There were no significantly different results with regard to pain, activities of daily living, mobility or strength. In the radiographic evaluation, it was found that the scaphometacarpal height was better preserved in group B. The mean time taken to achieve recovery was 10 weeks in group A and 4.5 in group B. Four cases with complications were recorded: one case of algoneurodystrophy in group A and two cases of dislocation and one case of fracture of the trapezium in group B. RESULTS: The results from prostheses were better than the results from the traditional treatment for rhizarthrosis using trapeziectomy with or without ligamentoplasty because of the rapid recovery that prostheses provide. CONCLUSION: However, prostheses should be applied carefully, because there is a potential for complications relating to the implants.

Artroplastia de excisão do trapézio e interposição tendinosa na rizartrose: estudo prospectivo / Arthroplasty for trapezium excision and tendon interposition in rhizarthrosis cases: prospective study

OBJETIVO: Avaliar prospectivamente os resultados de uma série de pacientes submetidos ao tratamento cirúrgico da rizartrose, com a técnica de ressecção do trapézio associada à interposição de um novelo do tendão abdutor longo do polegar. MÉTODOS: De maio a agosto de 2005, 10 pacientes foram submetidos ao tratamento cirúrgico da rizartrose. Foram incluídos pacientes com osteoartrose primária da articulação trapézio-metacárpica, estágios II, III, IV da classificação de Eaton, com dor persistente refratária ao tratamento clínico. Para avaliação funcional foi utilizada a escala visual analógica, questionário DASH e o escore de Buck-Gramcko. Na avaliação global do paciente foram mensuradas as forças de preensão palmar, pinça polpa a polpa, pinça lateral, pinça de três pontos, oponência e abduções radial e palmar. Realizou-se, ainda, o índice de migração do primeiro metacarpal na radiografia de repouso e sob estresse. RESULTADOS: Foram considerados bons, no alívio da dor (p = 0,005), com melhora da função na avaliação pelo DASH módulos 2 (p = 0,02) e 3 (p = 0,022) O escore de Buck-Gramcko apresentou um resultado excelente e três ótimos. Houve melhora em quase toda avaliação global, sendo não significante apenas na pinça lateral e abdução. Em todos pacientes houve migração do primeiro metacarpal. CONCLUSÃO: A trapeziectomia associada à interposição de um novelo do tendão abdutor longo do polegar mostrou-se uma técnica de execução relativamente simples e eficaz no alívio da dor e na melhora funcional.

OBJECTIVE: To prospectively evaluate the results from a series of patients who underwent surgical treatment for rhizarthrosis using the technique of trapezium resection associated with interposition of yarn from the long abductor tendon of the thumb. METHODS: From May to August 2005, ten patients underwent surgical treatment for rhizarthrosis. Patients with primary osteoarthrosis of the trapezium-metacarpal joint, in stages II, III and IV of the Eaton classification, with persistent pain that was refractory to clinical treatment, were included. For the functional assessment, the visual analogue scale, DASH questionnaire and Buck-Gramcko score were used. For the overall assessment on the patients, strength measurements were made for palm grip, pulp to pulp pinch, lateral pinch, three-point pinch, opposition and radial and palmar abductions. The migration index for the first metacarpal was also determined on radiographs at rest and under stress. RESULTS: The pain relief was considered to be good (p = 0.005), with functional improvements in modules 2 (p = 0.02) and 3 (p = 0.022) of DASH. The Buck-Gramcko score showed one excellent and three very good results. There was an improvement in almost all of the overall assessment and was only non-significant regarding lateral pinch and abduction. For all patients, there was migration of the first metacarpal. CONCLUSION: Trapeziectomy associated with interposition of yarn from the long abductor tendon of the thumb was shown to be a relatively simple and effective technique for pain relief and functional improvement.

Tratamento cirúrgico da rizartrose: trapezectomia com ou sem ligamentoplastia versus prótese total / Surgical treatment of rhizarthrosis: trapeziectomy with or without ligamentoplasty versus total prosthesis

OBJETIVO: O objetivo deste estudo consiste em rever os casos submetidos a tratamento cirúrgico por duas técnicas: trapezectomia com ou sem ligamentoplastia e artroplastia com implante. MÉTODOS: Foram avaliadas 52 mãos tratadas cirurgicamente por rizartrose entre 1995 a 2008: 32 trapezectomias com ou sem ligamentoplastia (grupo A) e 20 artroplastias com implante (grupo B). Follow-up médio: grupo A - 72 meses, grupo B - 23 meses. Não houve resultados significativamente diferentes quanto à dor, atividades da vida diária, mobilidade e força. No estudo radiográfico, a altura escafometacarpiana foi mais preservada no grupo B. O tempo médio de recuperação foi de 10 semanas no grupo A e de 4,5 no grupo B. Foram registradas quatro complicações: um caso de algoneurodistrofia no grupo A e 2 casos de luxação e um caso de fratura do trapézio no grupo B. RESULTADOS: O resultado das próteses superam o tratamento tradicional da rizartrose com trapezectomia com ou sem ligamentoplastia pela rápida recuperação que proporcionam. CONCLUSÃO: Contudo, a sua aplicação deve ser criteriosa, pois existe potencial de complicações relacionadas com os implantes.

OBJECTIVE: The aim of this study was to review cases that underwent surgical treatment using two techniques: trapeziectomy with or without ligamentoplasty and arthroplasty with implant. METHODS: Fifty-two hands that were surgically treated for rhizarthrosis between 1995 and 2008 were evaluated: 32 cases of trapeziectomy with or without ligamentoplasty (group A) and 20 with implant arthroplasty (group B). The mean follow-up for group A was 72 months and for group B, 23 months. There were no significantly different results with regard to pain, activities of daily living, mobility or strength. In the radiographic evaluation, it was found that the scaphometacarpal height was better preserved in group B. The mean time taken to achieve recovery was 10 weeks in group A and 4.5 in group B. Four cases with complications were recorded: one case of algoneurodystrophy in group A and two cases of dislocation and one case of fracture of the trapezium in group B. RESULTS: The results from prostheses were better than the results from the traditional treatment for rhizarthrosis using trapeziectomy with or without ligamentoplasty because of the rapid recovery that prostheses provide. CONCLUSION: However, prostheses should be applied carefully, because there is a potential for complications relating to the implants.

Comparative study between trapezium resection and tendon interposition with and without ligamentplasty in the management of carpometacarpal arthrosis of the thumb.

PURPOSE: Treating arthrosis in the base of the thumb has been a highly controverted subject. Many surgeries have been described, such as the isolated trapezium resection; resection with interposition with and without ligament plasty; arthrodesis, and arthroplasties. The purpose of this paper is to compare the two techniques which are currently the most used in this treatment. METHODS: A prospective study has been made to compare the surgical results between the trapezium resection with tendon interposition (tenoarthroplasty) - 22 cases - and tenoarthroplasty associated to ligament plasty-24 cases. Objective evaluation was done by measuring opponence, movements of the metacarpophalangeal joint, pinch and grasp strength, radiographic measurement of the distance between the base of first metacarpal and the scaphoid, and measurement of the angle between the first and the second metacarpals. Subjective evaluation was done with a DASH questionnaire, visual analog scale to evaluate pain and patient satisfaction. RESULTS AND CONCLUSION: After application of the criteria described and using Student 't' tests for statistical analysis, the authors concluded that the ligament reconstruction has no advantage over the simple resection and tendon interposition in carpometacarpal arthrosis of the thumb.

Estudo comparativo entre ressecção do trapézio e interposição tendinosa com e sem ligamentoplastia no tratamento da artrose carpometacarpiana do polegar / Comparative study between trapezium resection and tendon interposition with and without ligament plasty in the management of carpometacarpal arthrosis of the thumb

OBJETIVOS: O tratamento da artrose da base do polegar tem sido tema de grande controvérsia. Numerosas cirurgias têm sido descritas, como ressecção isolada do trapézio, ressecção com interposição com e sem reforço ligamentar, artrodese e artroplastias. O objetivo deste trabalho foi o de comparar os resultados das duas técnicas mais utilizadas nesse tratamento. MÉTODOS: Foi realizado estudo prospectivo a fim de comparar os resultados cirúrgicos de ressecção do trapézio com interposição tendinosa (tenoartroplastia) - 22 casos e tenoartroplastia associada a ligamentoplastia - 24 casos. A avaliação objetiva foi feita através das medidas de oponência, dos movimentos da articulação metacarpofalangiana, da força de pinça e de preensão, da medida radiográfica da distância entre a base do 1º metacarpiano e o escafóide e do ângulo entre o 1º e o 2º metacarpianos. A avaliação subjetiva foi realizada através do questionário DASH, uma escala analógico-digital para avaliar a dor e a satisfação do paciente. RESULTADOS E CONCLUSÃO: Após a aplicação dos critérios descritos e usada análise estatística pelo teste t de Student, os autores concluem não haver vantagens da reconstrução ligamentar sobre a simples interposição tendinosa na artrose carpometacarpiana do polegar.

OBJECTIVES: Treating arthrosis in the base of the thumb has been a highly controverted subject. Many surgeries have been described, such as the isolated trapezium resection; resection with interposition with and without ligament plasty, arthrodesis, and arthroplasties. The purpose of this paper is to compare the two techniques which are the most used in this treatment. METHODS: A prospective study has been made to compare the surgical results between the trapezium resection with tendon interposition (tendon arthroplasty) - 22 cases - and tendon arthroplasty associated to ligament plasty - 24 cases. Objective evaluation was done by measuring opponency, movements of the metacarpophalangeal joint, pinching and pressure strength, radiographic measurement of the distance between the first metacarpian and the scaphoid, and measurement of the angle between the first and the second metacarpian. Subjective evaluation was done with a DASH questionnaire, an analogical-digital scale to evaluate pain and patient satisfaction. RESULTS AND CONCLUSION: After application of the criteria described and using Student t test for statistical analysis, the authors concluded that the ligament reconstruction has no advantage over the simple tendon interposition in carpometacarpal arthrosis of the thumb.