114.
The Eaton-Glickel classification cannot predict clinical outcome after
total joint arthroplasty of the trapeziometacarpal joint
Lone Kirkeby, Torben Bæk Hansen
Department of Orthopaedics, Section of Hand Surgery, and The Orthopaedic
Research Unit Regional Hospital Holstebro, Denmark; Department of
Orthopaedics, Section of Hand Surgery, and The Orthopaedic Research Unit,
Regional Hospital Holstebro, Denmark.
Background:
The Eaton-Glickel classification is widely accepted for
evaluation of degenerative changes in the trapeziometacarpal (TMC) joint
including evaluation of subluxation and degenerative changes in the scaphoid-
trapezium (ST) joint. In total joint arthroplasty of the TMC joint the clinical
result may depend on the preoperative degenerative changes with subluxation
of the TMC joint and degenerative changes in the ST joint, and so far the
influence of these changes on clinical outcome is unknown.
Purpose / Aim of Study:
We wanted to investigate if the clinical result after
total joint arthroplasty of the trapeziometacarpal joint could be predicted from
preoperative degenerative changes evaluated using the Eaton-Glickel
classification.
Materials and Methods:
In a prospective study we included a total of 68
patients (14 males) mean age 59 years (range 41-77). All patients were
operated with total joint arthroplasty of the trapeziometarpal joint and clinical
follow-up was done after 3, 6 and 12 months. The preoperative degenerative
changes were classified according to the Eaton-Glickel classification based on
plain radiographs and CT scans. Eaton IV was defined as having discrete but
clear degenerative changes in the ST-joint. Patients with severe degenerative
changes in the ST joint were however excluded and treated with
trapeziectomy.
Findings / Results:
We found 26 patients with Eaton II, 29 with Eaton III and
12
patients with Eaton IV degenerative changes. All three groups had a good
clinical effect of the operation regarding pain, grip strength and DASH score,
and we found no significant difference between the three groups at any
measure point in the study. Also we found no difference between different
implant types.
Conclusions:
Classification of degenerative changes in the trapeziometacarpal
joint using the Eaton-Glickel classification cannot predict the clinical outcome
after total joint arthroplasty, and discrete but clear degenerative changes in the
ST-joint does not predict an inferior clinical outcome. Further research in
better preoperative evaluation methods is needed.
