Trapeziectomy with capsuloperiosteal flap interposition arthroplasty
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The technique described is a resection arthroplasty for advanced arthritis of the 1st Carpo-metacarpal joint (CMCJ) plus or minus associated Scapho-trapezio-trapezoid (STT) arthritis. Following sucessful surgery there is often a level of residual pain, from arthritis in the adjacent joints, but the expected outcome from a successful trapeziectomy is significant pain relief in the majority of patients (about 80%). One should however expect some loss of grip strength, though this is often not an in issue in the more elderly population for which this operation is indicated. The procedure can on occasion be complicated by excessive 1st metacarpo-phalangeal joint (MCPJ) hyperextension which can be quite a defunctioning condition in any age group.
Following a period of 6 weeks in a plaster cast and hand therapy the patient is expected to be much more comfortable using their hand however the pain reduction and strengthening often continue to improve up to 6 months post-procedure.
Author:Rajive Jose FRCS.
Institution: The Queen Elizabeth hospital, Birmingham, UK.