Suture Suspension Arthroplasty for Thumb Carpometacarpal Arthritis Reconstruction: Long-term Outcome: Level 4 Evidence

Abstract

A simple reconstructive method for treating advanced arthritis of the thumb carpometacarpal (CMC) joint with suture suspension arthroplasty (SSA) is a reliable, low morbidity procedure, providing a simpler alternative with similar long-term outcomes, compared to trapeziectomy procedures, with or without ligament reconstruction. SSA technique for thumb CMC arthritis reconstruction consists of trapeziectomy via a single volar incision and a four-strand intra-articular suture (0 gauge non-absorbable) suspension sling, creating a “hammock” between the distal-most insertions of the abductor pollicis longus and the flexor carpi radialis. This construct is pulled firmly, tethering the base of the thumb towards the base of the index metacarpal, correcting the subluxation deformity and maintaining arthroplasty space. All procedures were performed by the senior author, averaging 22 minutes operative time, followed by 14 days of post-operative immobilization, then short opponens splinting for four weeks and rehabilitation protocol (1DelSignore J.L. Accardi K.Z. Suture suspension arthroplasty technique for basal joint arthritis reconstruction.Tech Hand Upper Extrem Surg. 2009; 13: 166-172Crossref PubMed Scopus (29) Google Scholar), progressing to unrestricted use by 12 weeks. Long-term evaluation of 117 thumbs (average 89.4 months) with strength measurement and QuickDASH questionnaire, were analyzed with a paired t test. Final Xrays were obtained. 117 out of 153 thumbs in 110 patients (76% recall) were available for long-term follow up averaging 89.4 months (80-104 months). 96 patients were female, 21 male. Statistically significant (P < 0.05) improvement in pain relief, patient satisfaction, grip, key and tip pinch strength, and functional improvement was noted in the majority of patients. Average QuickDASH score (0.3) at final follow up indicated good to excellent satisfaction and functional use in the majority of patients. Xray evidence of subsidence averaged 30% (0-90%). One patient (0.8%) required revision surgery. Flexor carpi radialis rupture occurred in 7 (6%) thumbs after a sudden stress activity around 4-6 weeks post op, requiring no additional treatment. •Suture suspension arthroplasty for thumb CMC arthritis reconstruction is a simple, reliable method. Patient advantages include lower morbidity as a result of a single incision without tendon sacrificing, and avoidance of potential complications related to multiple incisions, tendon harvesting, drill hole formation, hardware implantation, pin fixation, or prolonged immobilization. Most patients are able to resume normal, unrestricted use at 12 weeks post-operative.•This method is cost-effective, utilizing less operative time, and does not require additional cost of implants or anchors.•Long-term results of suture suspension arthroplasty show similar outcomes as described with other methods of trapeziectomy, with or without ligament reconstruction (2Vermeulen G.M. Slijper H. Feitz R. Hovius S.E. Moojen T.M. Selles R.W. Surgical management of primary thumb carpometacarpal osteoarthritis: a systematic review.J Hand Surg Am. 2011; 36: 157-169Abstract Full Text Full Text PDF PubMed Scopus (265) Google Scholar), resulting in a very high degree of patient satisfaction, with a simple, minimally invasive, and cost-effective option.View Large Image Figure ViewerDownload Hi-res image Download (PPT)