Alnot J Y, Muller G P
Department of Upper Limb Surgery/Hand Emergencies/Hand Reimplantation, Bichat-Claude Bernard Hospital, Paris, France.
Rev Rhum Engl Ed. 1998 Feb;65(2):95-108.
The trapeziometacarpal joint is among the main targets for osteoarthritis at the hand. The objective of surgical treatment is to obtain a painless, stable, and mobile joint. One hundred fifteen cases treated either by a GUEPAR prosthesis (n = 90; group A) or by excision of the trapezium followed by ligament reconstruction and tendon interposition (n = 25; group B) were studied retrospectively. The choice between the two procedures was based on a number of clinical and radiological criteria. Of the 90 group A patients, 79 were reevaluated, after a mean follow-up of 5.75 years. Clinical results were good in 92% of cases. Loosening of the cup was seen in seven cases, of which three (3.8%) were treated by implantation of a Swanson prosthesis within three years of the first procedure. Six patients had loosening of the metacarpal component only, which was stable over time and had no adverse effect on clinical results. Of the 25 group B patients, 19 were reevaluated, after a mean follow-up of 3.5 years. Clinical results were good in 18 cases; the height of the scaphometacarpal space decreased by a mean of 51% versus its preoperative value. We conclude that the GUEPAR prosthesis provides good results with a low revision rate and deserves to be widely used in patients with a trapezium of at least 7 mm in height. Indications for the excision-reconstruction-interposition procedure include severe osteoarthritis, trapezium height less than 7 mm, younger age, and intensive hand use.
