Thesis

102 Part I Chapter 4 OA of the trapeziometacarpal (TMC) joint OA of the TMC joint is very common in older women, can cause severe pain and deformity and might result in marked disability. Pain relief, stability, mobility and strength are the main goals of surgical treatment. Several operative procedures have been established: metacarpal osteotomy, trapeziectomy, sometimes in combination with tendon interposition and/or ligament reconstruction, carpometacarpal arthrodesis and joint replacement [21]. All the different approaches have advantages and disadvantages and various appearances on postoperative imaging followup. At one year follow-up 19% of patients reported pain after trapeziectomy [22]. Nonunion rates in the literature after carpometacarpal arthrodesis are 8-21% [21]. Joint replacement operations have been established with silicone or Artelon TMC spacers, but studies comparing the Artelon spacer with trapeziectomy showed higher satisfaction rates in the trapeziectomy group (80%) compared with the joint replacement group [23]. Although conventional X-rays together with clinical history and examination are sufficient in most cases SPECT/CT can be used to image the metabolic activity of the OA and to show the structural alterations of the carpometacarpal joint in detail. In patients with persistent pain after these surgical procedures SPECT/CT might show the postoperative anatomic situation and persistent metabolic activity, as pain can be caused by impingement of the trapezoid or scaphoid- trapezoid osteoarthritis (Figure 3). Wrist arthrodesis Partial or complete wrist arthrodesis are established surgical procedures after traumatic injuries, in OA, and rheumatologic diseases [24, 25] (Table 1). Table 1 Main Indications and Frequency of Wrist (Partial) Arthrodesis [25] (Partial) Arthrodesis Indication Frequency Mediocarpal partial arthrodesis Carpal collapse, mediocarpal OA Frequent STT fusion Lunatum osteonecrosis, STT-OA, SL ligament tear Average RSL fusion Radiocarpal OA Average LT fusion Instable LT tear Very rare Complete wrist joint arthrodesis If partial arthrodesis is not indicated Rare LT, lunotriquetral; OA, osteoarthritis; RSL, radioscapholunar; STT, scaphoid, trapezium, trapezoid.

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