The failing trapeziometacarpal joint: from joint saving surgery to the consequences of its replacement

Scriptie/Masterproef: Doctoral Thesis


Our knowledge regarding the anatomy and pathology of the
trapeziometacarpal joint has evolved the last decennia. Recently some
anatomic descriptions have enhanced our understanding in the
pathophysiology of trapeziometarpal joint arthritis and the consequences
of its surgical treatment.
The most striking feature is the description of the dysplasia of the
trapezium and the importance of its slope in developing progressive
arthritis. In the past, surgeons focused on the soft tissue stabilising
options such as ligamentoplasty and osteotomy of the thumb metacarpal.
The osteotomy of the trapezium was recently considered. We proposed a
combination of both osteotomies together with a ligament reconstruction.
In order to verify the feasibility, we analysed anatomically the
vascularisation of the trapeziometacarpal joint. The combined technique
and the mid term results of the addition-subtraction osteotomy to correct
the increased slope of the trapezium and re-align the thumb metacarpal
is reported.
In case of failure of this technique or in case of to evolved arthritis of the
trapeziometacaral joint, joint replacement can be proposed. The best
results are obtained only in case of failure of all conservative treatment.
Despite good overall results of the proposed ball and socket replacement
we noted a high incidence of de Quervain tenovaginitis following the
implantation of these ball and socket prosthesis. The lengthening of the
thumb following this surgical procedure has been investigated as a
possible cause. A new test with a better sensitivity is proposed to
diagnose de Quervain’s disease.
Datum prijs20 sep 2013
Originele taalEnglish
Prijsuitreikende instantie
  • Vrije Universiteit Brussel
BegeleiderThierry Scheerlinck (Promotor), Pierre Casteleyn (Promotor), Christiaan Van Schravendijk (Jury), Erik Cattrysse (Jury), Michel De Maeseneer (Jury), Yves Allieu (Jury), Luc De Smet (Jury) & Frederic Schuind (Jury)

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