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J Hand Microsurg 2022; 14(03): 233-239
DOI: 10.1055/s-0040-1716607
Original Article

Lessons Learned: Trapeziectomy and Suture Suspension Arthroplasty for Thumb Carpometacarpal Osteoarthritis

Ashley L. Pistorio
1   Department of Plastic Surgery, UNLV School of Medicine, Las Vegas, Nevada, United States
,
John B. Moore
2   Premier Plastic Surgery, The University of Kansas Medical Center, Kansas, United States
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Abstract

In this study, we describe refinements of an accepted technique made by a single surgeon for trapeziectomy and suture suspension arthroplasty for thumb carpometacarpal (CMC) osteoarthritis after 220 cases over 4 years. Results are derived from 77 patients who underwent treatment using this technique comparing postoperative results with preoperative assessment and had sufficient data for inclusion. The surgical technique is described, including tips and modifications to avoid known possible complications. All patients in this study had advanced Eaton stage III or IV osteoarthritis. Grip strength and key pinch showed statistically significant improvement, and the improvement in palmar pinch approached significance. Pain scores were significantly decreased with over 50% of the patients rating their pain at 0 postoperatively. The overall complication rate was very low, and improvements in technique were made to mitigate future occurrence. This surgical technique for the treatment of thumb CMC arthritis achieved pain relief and recreated ligamentous support of the base of the first metacarpal to resist proximal migration after trapeziectomy, providing an increase in grip strength and key pinch with return of range of motion early in the postoperative period. Refinements on this technique through a large volume single surgeon experience provide technical tips for optimizing outcomes.

Keywords

carpometacarpal - ligament reconstruction and tendon interposition - mini tight rope fixation - thumb arthritis


Publication History

Article published online:
17 September 2020

© 2020. Society of Indian Hand Surgery & Microsurgeons. All rights reserved.

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  • References

  • 1 Anakwe RE, Middleton SD. Osteoarthritis at the base of the thumb. BMJ 2011; 343: d7122
    CrossrefPubMedGoogle Scholar
  • 2 Van HeestAE, Kallemeier P. Thumb carpal metacarpal arthritis. J Am Acad Orthop Surg 2008; 16 (03) 140-151
    CrossrefPubMedGoogle Scholar
  • 3 Ghavami A, Oishi SN. Thumb trapeziometacarpal arthritis: treatment with ligament reconstruction tendon interposition arthroplasty. Plast Reconstr Surg 2006; 117 (06) 116e-128e
    CrossrefPubMedGoogle Scholar
  • 4 Eaton RG, Lane LB, Littler JW, Keyser JJ. Ligament reconstruction for the painful thumb carpometacarpal joint: a long-term assessment. J Hand Surg Am 1984; 9 (05) 692-699
    CrossrefPubMedGoogle Scholar
  • 5 Badia A. Trapeziometacarpal arthroscopy: a classification and treatment algorithm. Hand Clin 2006; 22 (02) 153-163
    CrossrefPubMedGoogle Scholar
  • 6 Haara MM, Heliövaara M, Kröger H. et al Osteoarthritis in the carpometacarpal joint of the thumb. Prevalence and associations with disability and mortality. J Bone Joint Surg Am 2004; 86 (07) 1452-1457
    CrossrefPubMedGoogle Scholar
  • 7 MacDermid JC, Wessel J, Humphrey R, Ross D, Roth JH. Validity of self-report measures of pain and disability for persons who have undergone arthroplasty for osteoarthritis of the carpometacarpal joint of the hand. Osteoarthritis Cartilage 2007; 15 (05) 524-530
    CrossrefPubMedGoogle Scholar
  • 8 Chung KC, Pillsbury MS, Walters MR, Hayward RA. Reliability and validity testing of the Michigan Hand Outcomes Questionnaire. J Hand Surg Am 1998; 23 (04) 575-587
    CrossrefPubMedGoogle Scholar
  • 9 Bellamy N, Campbell J, Haraoui B. et al Clinimetric properties of the AUSCAN Osteoarthritis Hand Index: an evaluation of reliability, validity and responsiveness. Osteoarthritis Cartilage 2002; 10 (11) 863-869
    CrossrefPubMedGoogle Scholar
  • 10 Day CS, Gelberman R, Patel AA, Vogt MT, Ditsios K, Boyer MI. Basal joint osteoarthritis of the thumb: a prospective trial of steroid injection and splinting. J Hand Surg Am 2004; 29 (02) 247-251
    CrossrefPubMedGoogle Scholar
  • 11 Burton RI, Pellegrini Jr VD. Surgical management of basal joint arthritis of the thumb. Part II. Ligament reconstruction with tendon interposition arthroplasty. J Hand Surg Am 1986; 11 (03) 324-332
    CrossrefPubMedGoogle Scholar
  • 12 Tomaino MM, Pellegrini J VD, Burton RI. Arthroplasty of the basal joint of the thumb. Long-term follow-up after ligament reconstruction with tendon interposition. J Bone Joint Surg Am 1995; 77 (03) 346-355
    CrossrefPubMedGoogle Scholar
  • 13 Kriegs-Au G, Petje G, Fojtl E, Ganger R, Zachs I. Ligament reconstruction with or without tendon interposition to treat primary thumb carpometacarpal osteoarthritis. Surgical technique. J Bone Joint Surg Am 2005; 87 (Pt 1) (Suppl. 01) 78-85
    PubMedGoogle Scholar
  • 14 Sakai N. Interposition arthroplasty using trapezium tendon ball for osteoarthritis of the carpometacarpal joint of the thumb. Tech Hand Up Extrem Surg 2006; 10 (02) 68-72
    CrossrefPubMedGoogle Scholar
  • 15 Sirotakova M, Figus A, Elliot D. A new abductor pollicis longus suspension arthroplasty. J Hand Surg Am 2007; 32 (01) 12-22
    CrossrefPubMedGoogle Scholar
  • 16 Naidu SH, Poole J, Horne A. Entire flexor carpi radialis tendon harvest for thumb carpometacarpal arthroplasty alters wrist kinetics. J Hand Surg Am 2006; 31 (07) 1171-1175
    CrossrefPubMedGoogle Scholar
  • 17 Taghinia AH, Al-Sheikh AA, Upton J. Suture anchor suspension and fascia lata interposition arthroplasty for Basal joint arthritis of the thumb. Plast Reconstr Surg 2008; 122 (02) 497-504
    CrossrefPubMedGoogle Scholar
  • 18 Roman PB, Linnell JD, Moore JB. Trapeziectomy arthroplasty with suture suspension: short- to medium-term outcomes from a single-surgeon experience. J Hand Surg Am 2016; 41 (01) 34-39.e1
    CrossrefPubMedGoogle Scholar
  • 19 MacDermid J, Solomon G, Valdes K. Clinical Assessment Recommendations 3rd ed.. Mount Laurel, NJ: American Society of Hand Therapists; 2015
  • 20 Gangopadhyay S, McKenna H, Burke FD, Davis TR. Five- to 18-year follow-up for treatment of trapeziometacarpal osteoarthritis: a prospective comparison of excision, tendon interposition, and ligament reconstruction and tendon interposition. J Hand Surg Am 2012; 37 (03) 411-417
    CrossrefPubMedGoogle Scholar
  • 21 Cooney III WP, Chao EY. Biomechanical analysis of static forces in the thumb during hand function. J Bone Joint Surg Am 1977; 59 (01) 27-36
    CrossrefPubMedGoogle Scholar
  • 22 Khalid M, Jones ML. Index metacarpal fracture after tightrope suspension following trapeziectomy: case report. J Hand Surg Am 2012; 37 (03) 418-422
    CrossrefPubMedGoogle Scholar
  • 23 Tomaino MM. Suspensionplasty for basal joint arthritis: why and how. Hand Clin 2006; 22 (02) 171-175
    CrossrefPubMedGoogle Scholar
  • 24 Davis TRC, Brady O, Dias JJ. Excision of the trapezium for osteoarthritis of the trapeziometacarpal joint: a study of the benefit of ligament reconstruction or tendon interposition. J Hand Surg Am 2004; 29 (06) 1069-1077
    CrossrefPubMedGoogle Scholar
  • 25 Loukia K, Papatheodorou LK, Winston JD. et al Revision of failed thumb carpometacarpal arthroplasty. Hand Surg Am 2017; 42 (12) 1-7
    PubMedGoogle Scholar