Purpose
Most studies have demonstrated little difference in the outcome of the various techniques
proposed for the surgical treatment of thumb carpometacarpal (CMC) arthritis. However,
the difficulty and time required to perform each technique vary widely. In addition,
the introduction of recent implants has increased the cost of the overall procedure.
We hypothesize that using a simple, yet stable, suture suspension technique without
tendon interposition or ligament reconstruction yields similar results to conventional
approaches with less operative time.
Methods
Three hundred twenty consecutive patients underwent thumb CMC arthroplasty by trapezial
excision and metacarpal suspension using #2 high-strength orthopedic suture locked
weave alone passed from the distal most abductor pollicis longus and flexor carpi
radialis insertions without K-wire fixation or tendon transfer. Average duration of
preoperative symptoms was 17.8 months. Patient radiographs were graded for arthritis
severity and a visual analog scale (VAS) pain score (scale 0–10) obtained. Postoperative
clinical and radiological follow-up averaged 5.4 years (minimum, 24 months).
Results
The average age at surgery was 57.3 years and there were 221 women (243 procedures)
and 65 men (77 procedures). Average total operative time was 23.4 minutes. The dominant
hand was involved in 52% of patients. All had prior treatment including orthoses and
nonsteroidal anti-inflammatory drugs with 312 having had at least 1 steroid injection.
Five patients had stage 1, 134 had stage 2, 164 had stage 3, and 17 had stage 4 disease
on radiographs. Average trapezial space height on final follow-up radiographs was
0.8 cm. Two patients had complete trapezial space collapse and required a revision
procedure. The average VAS score was 0.6 with pain eliminated in 269 thumbs, minimal
in 49, and unchanged/worse in 2. All patients that were employed at the time of surgery
returned to work at an average of 2.3 months (range, 3–16 weeks).
Conclusions
Suture suspension thumb CMC arthroplasty provides comparable clinical results and
several advantages over many current techniques that are described in the literature.
The advantages include shortened operative time, inherent stability of the thumb metacarpal
height, and no necessity for K-wire fixation, tendon transfers, or implants.
Type of study/level of evidence
Therapeutic IV.
Key words
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Article info
Publication history
Accepted:
February 1,
2019
Received:
June 15,
2018
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2019 by the American Society for Surgery of the Hand. All rights reserved.
