Wilson Osteotomy Can Be a Reasonable Option for Adults With Carpometacarpal Osteoarthritis

Severe carpometacarpal (CMC) osteoarthritis in older patients is commonly treated with trapeziectomy followed by ligament reconstruction and tendon interposition, also called CMC arthroplasty. For symptomatic patients with early-stage CMC osteoarthritis, another option is Wilson osteotomy—a closing wedge osteotomy of the thumb metacarpal—but the evidence for it comes mostly from case series.

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Researchers at Massachusetts General Hospital found that in late-middle-aged patients with stage I/II CMC osteoarthritis, Wilson osteotomy may be a reasonable alternative to CMC arthroplasty.

Merel H. J. Hazewinkel, formerly a research fellow in the Hand and Arm Service of the Department of Orthopaedic Surgery, Jonathan Lans, MD, a resident in the Department, Neal C. Chen, MD, chief of the Hand and Arm Service, and colleagues published the findings in Hand.

Methods

The study included 17 adults who underwent primary Wilson osteotomy and 35 who underwent primary CMC arthroplasty at Mass General between January 1, 2002, and January 1, 2018. Three patients in the CMC arthroplasty group had Eaton–Littler stage I CMC osteoarthritis; all others had Eaton–Littler stage II. The median follow-up was 5.5 years (IQR, 2.4–9.5 years).

The mean age was 56, and 65% of patients were women. The mean age was significantly higher in the arthroplasty group than in the osteotomy group (58 vs. 52; P<0.001).

At a median of 8.3 years (IQR, 4.8–13 years) after surgery, 11 patients who underwent osteotomy and 17 who underwent arthroplasty completed outcomes questionnaires:

• The Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH)
• The Patient-Reported Outcomes Measurement Information System–Pain Interference (PROMIS PI) computer adaptive test
• A numeric rating scale of pain intensity during the past week
• A custom questionnaire assessing whether patients underwent reoperation

Outcomes

On chart review, the only postoperative outcome that differed significantly between groups was postoperative numbness, which was more common after osteotomy than arthroplasty (n=7 vs. n=4; P<0.05).

Regarding reoperation:

• Osteotomy—Two patients underwent implant removal for symptomatic implants and one underwent trapezium resection arthroplasty for pain
• Arthroplasty—One patient underwent revision arthroplasty for pain and one underwent arthrodesis of the metacarpophalangeal joint for hyperextension after arthroplasty

Other results were:

• Median QuickDASH score—10 overall (IQR, 4.5–27), 9.1 in the arthroplasty group and 14 in the osteotomy group (not significantly different vs. arthroplasty)
• Median NRS pain intensity score—0 overall (IQR, 0–1), 0 in the arthroplasty group and 1 in the osteotomy group (P<0.05 vs. arthroplasty)

Factors Influencing Outcomes

In bivariate analysis, higher QuickDASH scores were associated with higher PROMIS PI scores (r=0.82; P<0.05). In multivariable analysis, higher PROMIS PI scores were independently associated with higher pain intensity scores (β=0.13; P<0.05).

Guidance for Surgeons

Wilson osteotomy may be a reasonable alternative to CMC arthroplasty in late-middle-aged patients with stage I/II CMC osteoarthritis refractory to nonoperative management. This procedure might be advantageous for durability or preservation of pinch strength.

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Learn more about the Hand and Arm Service at Mass General

Learn more about the Harvard Combined Orthopedic Residency Program at Mass General