Gray (2007) — Hematoma and distraction arthroplasty for thumb basal joint osteoarthritis: minimum 6.5-year follow-up evaluation.

Hematoma and Distraction Arthroplasty for Thumb Basal Joint Osteoarthritis: Minimum 6.5-Year Follow-Up Evaluation.

Gray, Meals·J Hand Surg Am·2007·133 citations·Hand & Upper

Prospective single-arm study of 22 patients evaluating hematoma and distraction arthroplasty (HDA) — complete trapezial excision plus temporary K-wire distraction without ligament reconstruction or tendon interposition — for thumb basal joint arthritis at a minimum 6.5-year follow-up (average 88 months). Asks whether short-term results hold up over time.

Study Snapshot

Design

Prospective cohort

Setting: Single center, single surgeon, Los Angeles

Objective

Determine whether hematoma and distraction arthroplasty maintains durable outcomes at 6.5+ years

Outcome(s)

Pain relief, strength, motion, and function at 88 months

Subjects

22 thumbs in 22 patients, thumb basal joint OA

Total trapeziectomy + 5-week K-wire distraction fixation, no reconstruction

Inclusion

Clinical + radiographic peritrapezial arthritis

Follow-up

Mean 88 months (range 79–102)

Statistics

Paired t-testSpearman correlation

Key Findings

82% of patients (18/22) were completely pain-free at 88-month follow-up — matching or exceeding the 77% rate at 6 months — and all 22 patients rated themselves "very satisfied" with no revision surgeries
Grip and tip pinch strength were 22% above preoperative values at 88 months (p≤0.05); peak gains at 2 years were higher (40% grip increase), with modest decline thereafter mirrored by the nonsurgical contralateral hand — implicating age rather than procedure failure
Radiographic scaphoid–thumb metacarpal distance collapsed 77% by 88 months (10 mm → 2 mm), yet showed zero correlation with pain, strength, or functional outcomes — subsidence is not a valid surrogate for clinical failure
Range of motion held durably: 21/22 thumbs achieved full adduction into the palm and 20/22 opposed to the small finger metacarpal head at final follow-up
Dexterity (Jebsen subtests) returned to near-baseline at 88 months after early improvement, with parallel decline in nonsurgical hands — further supporting an age effect rather than late procedural deterioration

Clinical Relevance

When counseling patients on surgical options for thumb CMC arthritis, HDA — simple trapeziectomy with temporary K-wire distraction — offers durable pain relief and strength gains at 7+ years without the added operative complexity, donor-site morbidity, or longer surgical time of LRTI; don't let progressive radiographic subsidence on follow-up imaging prompt unnecessary concern or revision unless the patient is symptomatic.

Supplemental

Hematoma and Distraction Arthroplasty for Thumb Basal Joint Osteoarthritis: Minimum 6.5-Year Follow-Up Evaluation.

Gray, Meals·J Hand Surg Am·2007·133 citations·Hand & Upper

Hematoma and Distraction Arthroplasty for Thumb Basal Joint Osteoarthritis: Minimum 6.5-Year Follow-Up Evaluation.

Study Snapshot

Key Findings

Clinical Relevance

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Hematoma and Distraction Arthroplasty for Thumb Basal Joint Osteoarthritis: Minimum 6.5-Year Follow-Up Evaluation.

Study Snapshot

Key Findings

Clinical Relevance

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Hematoma and Distraction Arthroplasty for Thumb Basal Joint Osteoarthritis: Minimum 6.5-Year Follow-Up Evaluation.

Study Snapshot

Key Findings

Clinical Relevance

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Hematoma and Distraction Arthroplasty for Thumb Basal Joint Osteoarthritis: Minimum 6.5-Year Follow-Up Evaluation.

Study Snapshot

Key Findings

Clinical Relevance

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