Association between first ray lengthening and de Quervain tenosynovitis after trapeziometacarpal joint replacement

Abstract

Purpose: Trapeziometacarpal joint replacement is an effective treatment for trapeziometacarpal osteoarthritis, but postoperative de Quervain tenosynovitis remains a concern, with reported incidences of 4-17%. Thumb lengthening has been suggested as contributory. This study evaluated the association between postoperative thumb lengthening and de Quervain tenosynovitis using the M1-M2 arch described by Duche and Trabelsi.<br /> Methods: A retrospective cohort study included 49 patients (53 procedures) who underwent primary trapeziometacarpal joint replacement with a dual-mobility ball-and-socket implant. Thumb lengthening was quantified radiographically with the M1-M2 arch on thumb abduction and Kapandji frontal views. De Quervain tenosynovitis was diagnosed clinically and using ultrasound. An association between thumb lengthening and de Quervain tenosynovitis was assessed using point-biserial correlation analysis.<br /> Results: De Quervain tenosynovitis occurred in 14 of 53 wrists (26.4%), with a mean onset of 8.2 weeks. Patients with de Quervain tenosynovitis demonstrated greater thumb lengthening than those without, on both the abduction view (2.46 f 1.46 mm vs. 0.75 f 1.00 mm) and Kapandji frontal view (2.37 f 1.39 mm vs. 0.34 f 0.74 mm). Strong correlation was found between de Quervain tenosynovitis and thumb lengthening on the Kapandji frontal view and moderate correlation was found on the abduction view. Inter-observer reliability for the M1-M2 arch measurement was good, with an ICC of 0.88 for the Kapandji view and 0.84 for the thumb abduction view.<br /> Conclusion: Greater postoperative thumb lengthening was associated with de Quervain tenosynovitis following trapeziometacarpal joint replacement. These findings suggest that attention to restoration of thumb column length may be relevant in reducing the risk of postoperative de Quervain tenosynovitis. Prospective studies with large cohorts and standardized imaging protocols are warranted to clarify this relationship.<br /> Level of evidence: III