Impact of Osteoarthritis and Total Joint Arthroplasty on the Kinematics of the Trapeziometacarpal Joint: A Pilot Study

J Hand Surg Am. 2018 Apr;43(4):382.e1-382.e10. doi: 10.1016/j.jhsa.2017.10.011. Epub 2017 Nov 14.

Abstract

Purpose: To quantify the effect of osteoarthritis (OA) and total trapeziometacarpal (TMC) joint replacement on thumb kinematics during the primary physiological motions of the thumb.

Methods: We included 4 female patients with stage III TMC OA. A computed tomography-based markerless method was used to quantify the 3-dimensional thumb kinematics in patients before and after TMC joint replacement surgery with the Arpe implant.

Results: Trapeziometacarpal OA led to a marked decrease of internal rotation and abduction of the first metacarpal (MC1) during thumb flexion and a decrease of MC1 adduction during thumb adduction. As a compensatory phenomenon, the trapezium displayed increased abduction. The absence of MC1 translation in the ball-and-socket implant seems to induce a decrease of MC1 adduction as well as a decrease of trapezium adduction during thumb adduction, compared with OA and healthy joints. Implant replacement displayed an unchanged MC1 flexion during thumb flexion and seemed to slightly increase MC1 axial rotation during thumb flexion and adduction. Abduction and adduction of the MC1 are limited and compensated by this somewhat increased axial rotation, allowing more efficient thumb opposition.

Conclusions: The study highlights that advanced TMC OA mainly restricts the MC1 mobility. We also showed that, whereas total joint arthroplasty is able to restore thumb function, it cannot fully replicate the kinematics of the healthy TMC joint.

Clinical relevance: The quantification of TMC joint kinematics in OA and implanted patients is essential to improve our understanding of TMC OA as well as to enhance the functionality of implant designs.

Keywords: Implant; OA; TMC joint; medical imaging; thumb.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Arthroplasty, Replacement*
  • Biomechanical Phenomena / physiology
  • Carpometacarpal Joints / diagnostic imaging
  • Carpometacarpal Joints / physiopathology*
  • Carpometacarpal Joints / surgery*
  • Case-Control Studies
  • Female
  • Humans
  • Imaging, Three-Dimensional
  • Metacarpal Bones / diagnostic imaging
  • Metacarpal Bones / surgery
  • Middle Aged
  • Osteoarthritis / physiopathology
  • Osteoarthritis / surgery*
  • Pilot Projects
  • Rotation
  • Thumb / diagnostic imaging
  • Thumb / physiopathology
  • Thumb / surgery*
  • Tomography, X-Ray Computed
  • Trapezium Bone / diagnostic imaging
  • Trapezium Bone / surgery