Five-Year Results of Suture Suspension Thumb CMC Arthroplasty

Abstract

Ownership Interest: IlluminOss Medical (Weiss) Receipt of Intellectual Property: IlluminOss Medical (Weiss) Royalty: Medartis, Extremity Medical, Arthrosurface (Weiss) Most studies have demonstrated little difference in the outcome of the various techniques proposed for the treatment of thumb 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 far less operative time and economic cost. 320 consecutive patients underwent thumb CMC arthroplasty by trapezial excision and metacarpal suspension using number 2 high-strength orthopedic suture locked weave alone passed from the distal most APL and FCR insertions without K-wire fixation or tendon transfer by the senior surgeon. Average duration of preoperative symptoms was 17.8 months. Patient radiographs were graded for arthritis severity and a VAS pain score (scale 0–10) obtained. Average preoperative Eaton score was 2.6 with a VAS pain score of 7.9 (range of 5–10 on a 0–10 scale). Postoperative clinical and radiological follow-up averaged 5.4 years (minimum of 24 months). The average age at surgery was 57.3 years with 221 females (243 procedures) and 65 males (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 NSAIDs, with 312 having at least one 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 (Figure 58-1). The average VAS score was 0.6 with pain eliminated in 269 thumbs, minimal in 49, and unchanged/worse in 2. All patients who were employed at the time of surgery returned to work at an average of 2.3 months (range 3–16 weeks). Suture suspension thumb CMC arthroplasty appears to provide equal clinical results and several advantages over many current techniques:•Shortened operative time•Inherent stability of the thumb metacarpal height•No requirement for K-wire fixation•No requirement for tendon transfer•No requirement for implants•Simple technique with minimal cost