The Effect of Surgical Treatments for Trapeziometacarpal Osteoarthritis on Wrist Biomechanics: A Cadaver Study

Darshan S Shah, Claire Middleton, Sabahat Gurdezi, Maxim D Horwitz, Angela E Kedgley, Darshan S Shah, Claire Middleton, Sabahat Gurdezi, Maxim D Horwitz, Angela E Kedgley

Abstract

Purpose: Studies have shown the effects of surgical treatments for trapeziometacarpal osteoarthritis on thumb biomechanics; however, the biomechanical effects on the wrist have not been reported. This study aimed to quantify alterations in wrist muscle forces following trapeziectomy with or without ligament reconstruction and replacement.

Methods: A validated physiological wrist simulator replicated cyclic wrist motions in cadaveric specimens by applying tensile loads to 6 muscles. Muscle forces required to move the intact wrist were compared with those required after performing trapeziectomy, suture suspension arthroplasty, prosthetic replacement, and ligament reconstruction with tendon interposition (LRTI).

Results: Trapeziectomy required higher abductor pollicis longus forces in flexion and higher flexor carpi radialis forces coupled with lower extensor carpi ulnaris forces in radial deviation. Of the 3 surgical reconstructions tested post-trapeziectomy, wrist muscle forces following LRTI were closest to those observed in the intact case throughout the range of all simulated motions.

Conclusions: This study shows that wrist biomechanics were significantly altered following trapeziectomy, and of the reconstructions tested, LRTI most closely resembled the intact biomechanics in this cadaveric model.

Clinical relevance: Trapeziectomy, as a standalone procedure in the treatment of trapeziometacarpal osteoarthritis, may result in the formation of a potentially unfilled trapezial gap, leading to higher wrist muscle forces. This biomechanical alteration could be associated with clinically important outcomes, such as pain and/or joint instability.

Keywords: Arthroplasty; LRTI; simulator; trapeziectomy; trapeziometacarpal osteoarthritis.

Copyright © 2020 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1
Figure 1
Schematic of the physiological wrist simulator.
Figure 2
Figure 2
Mean muscle forces of the APL, FCR, and ECU across 9 specimens during FE-5030 and RUD-15 in the intact specimens (dashed lines) and following trapeziectomy (solid lines). Error bars represent 1 SD. The asterisk (*) represents statistically significant differences between trapeziectomy and intact cases (P < .01).
Figure 3
Figure 3
Mean muscle forces of the APL, FCR, and ECU across 9 specimens during FE-5030 and RUD-15 in the intact specimens (dashed lines) and following suture suspension arthroplasty (solid lines). Error bars represent 1 SD. The asterisk (*) represents statistically significant differences between suture suspension arthroplasty and intact cases (P < .01).
Figure 4
Figure 4
Mean muscle forces of the APL, FCR, and ECU across 7 specimens during FE-5030 and RUD-15 in the intact specimens (dashed lines) and following prosthetic replacement (solid lines). Error bars represent 1 SD. The asterisk (*) represents statistically significant differences between prosthetic replacement and intact cases (P < .01).
Figure 5
Figure 5
Mean muscle forces of the APL, FCR, and ECU across 6 specimens during FE-5030) and RUD-15 in the intact specimens (dashed lines) and following LRTI (solid lines). Error bars represent 1 SD. The asterisk (*) represents statistically significant differences between LRTI and intact cases (P < .01).

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