Significance and implications of partial trapezoidectomy in management of scapho-trapezio-trapezoid (STT) osteoarthritis.

Background: Trapeziectomy with partial trapezoid excision is a common procedure for scapho-trapezio-trapezoidal osteoarthritis (STT OA). This study seeks to determine the impact of performing partial trapezoidectomy in the treatment of STT OA.

Methods: An IRB-approved retrospective review of patients who received trapeziectomy for isolated STT OA was conducted. Patients who received partial trapezoidectomy (PT group) were matched to patients who did not (NT group) via propensity-score matching. Patient demographics, clinical findings, and patient-reported outcomes (PROMs) were collected. Second metacarpal subsidence was measured. Radiographic and clinical outcomes were compared between the PT and NT groups.

Results: Fifty-three patients underwent 56 trapeziectomies, with 28 hands receiving partial trapezoidectomy. The median pain score reduction was 5 [3-7] in the PT group and 2.75 [1-5.9] in the NT group (p=0.03). QuickDASH scores decreased from 47.73 [30.68-67.61] to 11.36 [6.82-29.55] (p=0.002) and from 60.23 [50.57-75] to 23.87 [5.12-33.52] (p=0.005) for PT and NT, respectively. VR12 scores improved from 33.86 [30.05-40.62] to 46.77 [43.7-53.68] for PT (p=0.0003) and from 37.21 [30.61-42.84] to 51.97 [37.7-55.7] for NT (p=0.05). Change in QuickDASH (p=0.66) and VR12 scores (p=0.88) were not significantly different between groups. Median second metacarpal subsidence was 12.6% [-0.6-31.5] and 3.5% [-15.9-15.4] respectively for PT and NT (p=0.031). There was no correlation between subsidence and pain in either group (PT: p=0.43, NT: p=0.31).

Conclusions: Both procedures improved pain and PROMs for STT OA, with partial trapezoidectomy demonstrating superior pain reduction compared to trapeziectomy alone. Increased second metacarpal subsidence following partial trapezoidectomy did not adversely impact clinical outcomes.