Suspensionplasty using Anchors and Non-Absorbable Sutures for Rhizarthrosis

Abstract

Objective To analyze the clinical and radiographic results of patients with rhizarthrosis who underwent surgical treatment for resection of the trapezium bone using a fixation system with anchors and a non-absorbable suture.

Methods Fifteen patients with a mean age of 60.26 years old were studied. Fourteen patients had type III rhizarthrosis and 1 had type II rhizarthrosis, according to the Eaton-Littler classification. Data on the professional activity, affected side, and hand dominance were collected and evaluated for the presence of pain, degree of joint movement of the radial abduction of the thumb, opposition, and palmar grip strength. The upper limb function was assessed using the Quick Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. The patients were subjected to pre and postoperative radiographic examinations, by which the scaphoid-first metacarpal height was measured using the oblique view of the hand. Suspensionplasty by fixation was then performed using a system of two 2.0 mm threaded bone anchors and a 2.0 mm Ethibond (Ethicon, Inc., Somerville, NJ, USA) suture wire. Finally, the trapezium bone was resected.

Results The mean follow-up duration was 21.50 ± 5.02 months. The patients showed a mean score of 1.6 in the final evaluation using the visual analog scale. The degree of joint movement of the abduction of the thumb was on average 61.67° postoperatively and 59.73° preoperatively. There was an improvement in thumb opposition and a significant improvement in the upper limb function, as assessed using the Quick DASH method. The scaphoid-first metacarpal height had a proximal migration of ∼ 50% in the postoperative radiographs. The mean time to return to daily living activities was 20.7 days, 24.7 days to practical life activities, and 101.3 days to work activities. There was no correlation between the level of professional activity and the incidence of the disease.

Conclusions Trapeziectomy and suspensionplasty, using an anchorage system and a non-absorbable suture, shows a significant improvement in pain, opposition, and function of the affected upper limb, and is efficient for the surgical treatment of rhizarthrosis. It allows for a rapid return to daily living activities with a low risk for complications.

Resumen

Objetivo Analizar los resultados clínicos y radiográficos de pacientes con rizartrosis sometidos a tratamiento quirúrgico para la resección del trapecio utilizando un sistema de fijación con anclajes y una sutura no reabsorbible.

Material y Método Se estudiaron 15 pacientes con una edad media de 60,26 años. Catorce pacientes tenían rizartrosis tipo III y uno rizartrosis tipo II, de acuerdo con la clasificación de Eaton-Littler. Los datos sobre la actividad profesional, el lado afectado y la dominancia de la mano se recogieron y se evaluaron en cuanto a la presencia de dolor, el grado de movimiento articular de la abducción radial del pulgar, la oposición y la fuerza de agarre. La función del miembro superior se evaluó mediante el cuestionario Quick DASH. Los pacientes fueron sometidos a exámenes radiográficos preoperatorios y postoperatorios, mediante los cuales se midió la altura entre el primer metacarpiano y el escafoides en la proyección oblicua de la mano. La plastia de suspensión se realizó mediante fijación usando un sistema de dos anclajes óseos roscados de 2,0 mm y un alambre de sutura Ethibond ® de 2,0 mm (Ethicon INC, Somerville, Nueva Jersey). Finalmente, el hueso del trapecio fue resecado.

Resultados El tiempo medio de seguimiento fue 21,50 ± 5,02 meses. Los pacientes mostraron una puntuación media de 1,6 en la evaluación final usando la escala analógica visual. El grado de movimiento articular de la abducción del pulgar fue en promedio de 61.67° postoperatorio y de 59.73° preoperatorio. Hubo una mejora en la oposición del pulgar y una mejora significativa en la función del miembro superior, según se evaluó mediante el método Quick DASH. La altura entre el primer metacarpiano y el escafoides lugar tuvo una migración proximal de aproximadamente 50% en las radiografías postoperatorias. El tiempo promedio para regresar a las actividades de la vida diaria fue de 20,7 días, 24,7 días para las actividades de la vida práctica y 101,3 días para las actividades laborales. No hubo correlación entre el nivel de actividad profesional y la incidencia de la enfermedad.

Conclusiones La trapecectomía y la plastia en suspensión, utilizando un sistema de anclaje y una sutura no reabsorbible, muestran una mejoría significativa en el dolor, la oposición y la función de la extremidad superior afectada, y es eficiente para el tratamiento quirúrgico de la rizartrosis. Permite un retorno rápido a las actividades de la vida diaria con bajo riesgo de complicaciones.

Keywords

Osteoarthritis - trapezometacarpal joint - trapeziectomy - suspensionplasty - anchorage

Palabras clave

artrosis - articulación traperometacarpiana - trapecectomía - suspensoplastia - anclaje

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