Trapezial Topography in Thumb Carpometacarpal Arthritis

Abstract

Objective Contradictory reported arthritic patterns of the metacarpal surface of the trapezium include preferential volar wear, radial wear, and dorsal-ulnar sparing. We investigated whether a predominant wear pattern exists in surgical trapeziectomy for advanced thumb carpometacarpal (CMC) arthritis.

Methods We examined 36 intact trapezia from 34 thumb CMC arthroplasty patients over an 18-month period. The first metacarpal articular surface revealed three consistent morphology patterns: (1) saddle, (2) dish, and (3) cirque. The saddle represented cartilage loss with preservation of the normal trapezial morphology. The dish shape represented concave curvature, with loss of the normal saddle configuration. The cirque shape represented preferential volar concave wear, disrupting the convex volardorsal arc. Two surgeons classified the randomized specimens twice, blinded to patient identity and each other's categorization. Radiographic Eaton staging was correlated retrospectively for 35 of 36 of the trapezial specimens. Eight specimens were further quantified with micro-computed tomography (micro-CT).

Results Thirty-six trapezia were classified as follows: 17 (47%) saddle, 12 (33%) dish, and 7 (19%) cirque. Intra-rater reliability was 0.97 and 0.95; inter-rater reliability in the second round was 0.95. The 36 trapezia represented 27 female (75%) and 9 male (25%) patients; 18 (50%) represented the dominant hand. Age at surgery averaged 64 (33–76). Complete cartilage loss of the entire metacarpal surface was seen in 15 (42%) of all specimens. Osteophyte presence was typically minimal in the saddle group; the dish group had characteristic extensive rimming osteophytes in a 91% female population (11/12), and the cirque group had volar osteophytes. Radiographic severity ranged from Eaton stage II to IV; less severe radiographic staging (Eaton II) predominated in the saddle configuration; advanced Eaton III–IV disease predominated in both cirque and dish shapes. Micro-CT verified the three discrete shapes with volardorsal and radioulnar orientation measurements.

Conclusion The metacarpal surface of the trapezium demonstrates three distinct patterns of wear in arthritic surgical specimens. Sex, dominance, age distribution, and Eaton stage varied across the different shapes.

Level of Evidence Level 3

Study Type Observational

Keywords

Trapezium - CMC arthritis - abnormal loading - bone morphology

Note

All work was conducted at the Robert A. Chase Hand Center, Stanford University, Palo Alto, CA.

Ethical Review Committee Statement

IRB approved by Stanford University, titled “Investigation of Biochemical and Histological Properties in Upper Extremity Pathology.”

• References

• 1 Armstrong AL, Hunter JB, Davis TR. The prevalence of degenerative arthritis of the base of the thumb in post-menopausal women. J Hand Surg [Br] 1994; 19 (3) 340-341
• 2 Gray H, Lewis WH , ed. Anatomy of the Human Body. 20th ed. Philadelphia, PA: Lea & Febiger; 1918
• 3 Eaton RG, Glickel SZ. Trapeziometacarpal osteoarthritis. Staging as a rationale for treatment. Hand Clin 1987; 3 (4) 455-471
• 4 Marzke MW, Tocheri MW, Steinberg B , et al. Comparative 3D quantitative analyses of trapeziometacarpal joint surface curvatures among living catarrhines and fossil hominins. Am J Phys Anthropol 2010; 141 (1) 38-51
• 5 Tocheri MW, Razdan A, Williams RC, Marzke MW. A 3D quantitative comparison of trapezium and trapezoid relative articular and nonarticular surface areas in modern humans and great apes. J Hum Evol 2005; 49 (5) 570-586
• 6 Tocheri MW, Orr CM, Jacofsky MC, Marzke MW. The evolutionary history of the hominin hand since the last common ancestor of Pan and Homo . J Anat 2008; 212 (4) 544-562
• 7 Tocheri MW, Marzke MW, Liu D , et al. Functional capabilities of modern and fossil hominid hands: three-dimensional analysis of trapezia. Am J Phys Anthropol 2003; 122 (2) 101-112
• 8 Pellegrini Jr VD. Osteoarthritis of the trapeziometacarpal joint: the pathophysiology of articular cartilage degeneration. II. Articular wear patterns in the osteoarthritic joint. J Hand Surg Am 1991; 16 (6) 975-982
• 9 Nufer P, Goldhahn J, Kohler T, Kuhn V, Müller R, Herren DB. Microstructural adaptation in trapezial bone due to subluxation of the thumb. J Orthop Res 2008; 26 (2) 208-216
• 10 Xu L, Strauch RJ, Ateshian GA, Pawluk RJ, Mow VC, Rosenwasser MP. Topography of the osteoarthritic thumb carpometacarpal joint and its variations with regard to gender, age, site, and osteoarthritic stage. J Hand Surg Am 1998; 23 (3) 454-464
• 11 Eaton RG, Littler JW. Ligament reconstruction for the painful thumb carpometacarpal joint. J Bone Joint Surg Am 1973; 55 (8) 1655-1666
• 12 Outerbridge RE. The etiology of chondromalacia patellae. J Bone Joint Surg Br 1961; 43-B: 752-757
• 13 Wolf JM, Oren TW, Ferguson B, Williams A, Petersen B. The carpometacarpal stress view radiograph in the evaluation of trapeziometacarpal joint laxity. J Hand Surg Am 2009; 34 (8) 1402-1406
• 14 de Raedt S, Stilling M, van de Giessen M, Streekstra GJ, Vos FM, Hansen TB. A three-dimensional analysis of osteoarthritic changes in the thumb carpometacarpal joint. J Hand Surg Eur Vol 2012; ; [Epub ahead of print]
• 15 Lee AT, Williams AA, Lee J, Cheng R, Lindsey DP, Ladd AL. Trapezium Trabecular Morphology in Carpometacarpal Arthritis. J Hand Surg Am 2013; 38 (2) 309-315
• 16 Eaton RG. Replacement of the trapezium for arthritis of the basal articulations: a new technique with stabilization by tenodesis. J Bone Joint Surg Am 1979; 61 (1) 76-82
• 17 North ER, Eaton RG. Degenerative joint disease of the trapezium: a comparative radiographic and anatomic study. J Hand Surg Am 1983; 8 (2) 160-166
• 18 Halilaj E, Rainbow MJ, Got C, Schwartz JB, Moore DC, Weiss AP, Ladd AL, Crisco JJ. In vivo kinematics of the thumb carpometacarpal joint during three isometric functional tasks. Clin Orthop Relat Res 2013; May 17. [Epub ahead of print] PubMed PMID: 23681597.
• 19 Ladd AL, Weiss AP, Crisco JJ , et al. The thumb carpometacarpal joint: anatomy, hormones, and biomechanics. Instr Course Lect 2013; 62: 165-179