Isis® prosthesis versus partial trapeziectomy and interposition of a chondrocostal autograft : functionnal retrospective comparative study

Introduction: Rhizarthrosis remain a common problem with different surgical solutions. We report a retrospective comparative study of a prosthesis and a control group of partial trapeziectomy associated with interposition of a chondrocostal autograft Material and methods: prosthesis group: 17 prosthesis (Isis (R), screwed cup) implanted in 15 patients with an mean age of 62 yo between 2006 and 2009 with a mean follow up of 13 months. This serie was compared with a group of 57 patients with an mean age of 63 yo operated between 2005 and 2006 with a mean follow up of 47 months with a partial trapeziectomy and interposition of a chondrocostal autograft. A retrospective appariement was achieved (1 prosthesis was compared with 4 trapeziectomy) on the age and on the stage of the rhizarthrosis according to Dell. 2 surgeons not involved in the treatment evaluated retrospectively the 2 groups (Dash scoring, Kapandji scoring, pinch, grasp, radiological assesment of the impkant and of the cartilage graft) Results: No complication has been reported in the 2 groups. There were no differences between the 2 groups considering the dash score (prothesis : 18,58 / trapeziectomy + cartilage graft : 19,58), the kapandji score (prothesis : 9,46 / trapeziectomy + cartilage graft : 9,29), and pinch (prothesis : 4.66 kg/F / trapeziectomy + cartilage graft : 4.92 kg/F). But, the results were in favor of trapeziectomy + cartilage graft considering grasp (21.91 kg/F pour 14.8Kg/F) and abduction and anteposition respectively at 66,42 degrees and 66,78 degrees (prothesis) versus 71,35 degrees and 97,64 degrees (trapeziectomy + cartilage graft). Discussion: Both group have similary and comparative results concerning Dash scoring and global mobility. A highest follow up in the trapeziectomy + cartilage graft group can explain a best grasp mesurement. Implantation of trapezio metacarpal prosthesis is not recommended if trapezium is less than 8 mm. The main complication of trapezio metacarpal prosthesis remain the instability with dislocation. Loosening, the second main complication, seem to diminish secondary to modification of design of the implants. Series of trapeziectomy with high follow up report some complications at carpal level been but seem to be done under arthroscopy. Some different solution has probably to be proposed to different patients with adequate selection. As reported in recent series, trapeziometacarpal prosthesis seem to reach faster mobility and usefull thumb than trapeziectomy. (C) 2011 Elsevier Masson SAS. All rights reserved.