Management of the Trapezoid in Thumb Carpometacarpal Arthroplasty: A Survey of Recent Trends in Memebers of the American Society for Surgery of the Hand

Abstract

The purpose of this study was to assess the recent trends among hand surgeons regarding the role of partial trapezoid excision (PTE) in carpometacarpal (CMC) arthroplasty in both the absence and presence of concomitant scaphotrapeziotrapezoidal (STT) arthritis. In addition, surgeon and patient demographic data were evaluated to determine trends and factors that contribute to the decision-making process for trapezoid management.

An 11-question survey was distributed to the U.S. practicing body of hand surgeon members of the American Society for Surgery of the Hand. Survey questions collected information regarding surgeon training background, CMC arthroplasty techniques, and trapezoid management. Data were analyzed for trends using analyses of variance with Tukey post hoc tests, chi-square tests of independence, and Fisher's exact tests with post hoc comparisons with statistical significance set at p = 0.05.

The survey had an 18.7% response rate with 623 completed surveys. The most common treatment choice for intraoperative identification of STT arthritis was proximal trapezoid resection (80.4%). Surgeons with greater than 10 years in practice preferred trapeziectomy with ligament reconstruction and tendon interposition as their CMC treatment choice. Surgeons with less than 10 years in practice preferred suture suspensionplasty and were more influenced by STT arthritis and advanced Eaton–Littler arthritis stage to perform a PTE. Surgeons who frequently perform PTE were more influenced by patient demographic factors such as age and gender compared with surgeons who rarely perform PTE.

The predominant factor that influences surgeons to perform PTE is when concomitant STT arthritis is present. Patient demographic factors such as age and gender also influence a subset of surgeons to perform PTE; however, this may be based out of personal clinical judgement and experience rather than previously established evidence.

The current trends regarding PTE during CMC arthroplasty vary among hand surgeons and is based on experience rather than clinical evidence. Questionnaires such as this may be the nidus needed to initiate future studies to help standardize care.

Therapeutic Level IV.