First carpometacarpal joint arthritis. A comparison of two arthroplasty techniques.

Trapeziectomy followed by reconstruction of the intermetacarpal ligament using a small slip of extensor carpi radialis longus tendon and a wide slip of flexor carpi radialis for tendon interposition (group A) is compared with trapeziectomy followed by palmaris longus tendon interposition (group B). Group A included 11 hands in nine patients. Group B included eight hands in eight patients. Significant pain at the base of the thumb and 1st carpometacarpal joint degeneration were indications for surgery. Outcome was assessed by subjective questioning, objective clinical measurement and radiography. Group A appeared to have a slower recovery but later developed a stronger hand, better dynamic thumb function despite reduced movement and the resting trapezial space was better preserved. Calcification within the trapezial space correlated with better results but this took 3 years to occur. Patients in group B had greater relief of pain and were more consistently satisfied at an early stage.