Les problèmes de l'articulation métacarpophalangienne dans le traitement chirurgical de la rhizarthrose par prothèse contrainte type ARPE

Progressive ankylosis of the trapeziometacarpal joint in flexion-adduction with closure of the first web in advanced trapeziometacarpal osteoarthritis gradually leads to compensatory dislocation of the metacarpophalangeal joint with hyperextension in the sagittal plane and abduction in the frontal plane. This deformity of the MP joint, initially reducible, but subsequently irreducible, results in the classical 'Z' deformity of the thumb in the sagittal plane. A less well known 'Z' deformity can also occur in the frontal plane due to distension of the medial collateral ligament. Surgical treatment of trapeziometacarpal osteoarthritis by arthroplasty must correct this secondary deformity of the MP joint to obtain an optimal result. The classical sagittal 'Z' deformity of the thumb can be easily corrected while this deformity is still reductible by releasing the fist metacarpal by tightening the abductor pollicis longus. When it is irreducible, this deformity can only be treated by MP arthrodesis, which contraindicates insertion of the ARPE trapeziometacarpal implant. Correction of the frontal 'Z' deformity of the thumb requires repair of the medial collateral ligament of the MP joint by ligamentorraphy (retightening) or ligamentoplasty.