Osteoarthritis is the leading cause of loss of hand function in America and most commonly affects the carpometacarpal joint of the thumb. Although medication and exercise are possible treatments in mild cases, in cases of severe thumb osteoarthritis, surgery may be the only treatment option. One surgical approach is Mini TightRope (Arthrex, Inc., Naples, Fla.) suspensionplasty, which uses a suture wire to attach the base of the thumb metacarpal to the second metacarpal after removal of the trapezium. Current methods of clinical outcome assessment following hand surgery, such as questionnaires and goniometry, do not provide data that are well suited for improving surgical or mechanical design. Also, current in vivo studies investigating changes following this operation have primarily focused on pain, and not function. Surgical design and surgical devices require engineering, and data from patient outcomes by questionnaires and current clinical tests may not provide data that are well suited to improving surgical or mechanical design. To improve patient care and to foster device design, it is critical to understand how the function of the thumb—specifically, motion and forces—changes because of surgery to give patients the best treatment possible. We have developed a force motion capture device that records the joint range of motion of the thumb coupled with measurement of applied forces at different points within the range or motion. The goal of this work was to illustrate how the force motion capture device could be used to quantify function preoperatively and postoperatively for basal joint arthroplasty. A patient who was scheduled for Mini TightRope suspensionplasty was tested before surgery, 6 weeks after surgery, and again 12 weeks after surgery. Thumb forces and the kinematic range of motion were measured over the kinematic space and analyzed to determine changes between preoperatively and postoperatively in magnitude, the range of force directions, and the volume of the kinematic space used to apply forces (Fig. 1).Fig. 1.: Force motion capture. Force capabilities were measured using both a six-axis load cell and motion capture at multiple positions and directions; shown are palm at (left) 0 degrees (horizontal) and force directed medially (right) and palm at 60 degrees with respect to horizontal with force directed toward the ground. Range of motion was also measured using reflective markers and motion capture and through full flexion of the metacarpophalangeal and interphalangeal joints of the thumb and full ranges of opposition and abduction.Functional changes in the participant’s hand were quantified using force motion capture. Figure 2 was the result of force motion capture for the individual. It describes how the participant’s kinematic range of motion (gray space) changed relative to a healthy individual (white space), and how the forces that participant was able to apply changed because of force application (colored arrows). Overall, the forces that this participant could apply decreased in both magnitude and volume of the kinematic space used to apply the force, drastically following the surgery, then returned to a similar but not significantly improved degree of function after 12 weeks from their initial condition. The range of directions the participant was able to apply forces in did not change because of the surgery.Fig. 2.: Differences in force production for one participant. Visualized force profiles over the range of motion for a participant at each testing point. The white space is that from a healthy thumb (two-dimensional projection). The grey-shaded region is the kinematic space from the participant at each time point (left, before surgery; center, 6 weeks after surgery; right, 12 weeks after surgery and at completion of physical therapy). The colored arrows indicate the force production, with hotter colors indicating more force. The direction of the arrow indicates direction of the force application.Force motion capture provides a descriptive, accurate, and efficient method to measure the functional abilities of the thumb and compare them over time. These functional test results make force motion capture a novel method of quantifying functional changes in the thumb and can be used track function throughout recovery and to compare different surgical treatments and device designs to determine which leads to the most function recovered. DISCLOSURE Dr. Clarkson has previously worked with Arthrex, the developer of the surgical device. Drs. Drost and Bush have no financial disclosures to report.
Read full abstract