Arch Hand Microsurg.  2018 Dec;23(4):223-229. 10.12790/ahm.2018.23.4.223.

Outcome of Suture Suspension Arthroplasty for Thumb Carpometacarpal Joint Arthritis

• Kim S
• Gong HS
• Lee SY
• Lee M
• Kim J
• Baek GH

• KMID: 2427387
• DOI: http://doi.org/10.12790/ahm.2018.23.4.223

Abstract

PURPOSE
A number of procedures were introduced to stabilize the 1st metacarpal bone after resection of the trapezium in the thumb carpometacarpal joint (CMCJ) arthroplasty. However, some surgical procedures may inevitably damage normal structures, such as harvesting tendons or drilling of a bone for tendon passage. Suture suspension arthroplasty is relatively less invasive and easier to perform than the previously described surgical methods. The purpose of this study was to report the therapeutic efficiency of the suture suspension arthroplasty.
METHODS
We retrospectively reviewed 12 patients who underwent suture suspension arthroplasty for the treatment of thumb CMCJ arthritis. Pain visual analogue scale (VAS), satisfaction about surgical outcomes, and the disabilities of the arm, shoulder and hand (DASH) scores were measured to evaluate the functional outcomes and the Trapezial Space Ratios were measured. Satisfaction was measured in the range of "very dissatisfied" (0) to "very satisfied" (10).
RESULTS
The mean follow-up period was 23 months. Pain VAS score improved significantly from 7.0 to 2.9 (p < 0.05). And mean satisfaction scale was 6.9. However, there was no significant difference in DASH scores between before and after surgery (p=0.06). The mean trapezial space ratio was calculated to be 0.45 before surgery, 0.33 immediately after surgery, 0.23 at the last follow-up.
CONCLUSION
Suture suspension arthroplasty is a satisfactory surgical procedure. And compared with other procedures, there is no significant difference in the reduction of the trapezial space. It may be useful in advanced thumb CMCJ arthritis.

Keyword

Carpometacarpal joint; Arthritis; Suture suspension arthroplasty

MeSH Terms

Arm
Arthritis*
Arthroplasty*
Carpometacarpal Joints*
Follow-Up Studies
Hand
Humans
Retrospective Studies
Shoulder
Sutures*
Tendons
Thumb*

Figure

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  Fig. 1 A skin incision of 2 cm is marked over the thumb carpometacarpal joint.

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  Fig. 2 A space between extensor pollicis brevis tendon and abductor pollicis longus tendon is identified. The extensor pollicis brevis tendon is retracted dorsally and the abductor pollicis longus tendon is retracted volarly.

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  Fig. 3 A longitudinal capsular incision is made along the carpometacarpal joint and the trapezium is excised.

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  Fig. 4 A needle with a non-absorbable suture (2-0 Ethibond) is passed through the flexor carpi radialis tendon, as close as possible to the 2nd metacarpal bone insertion.

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  Fig. 5 The suture needle is passed through the abductor pollicis longus tendon from outside to inside to the trapezial space.

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  Fig. 6 The suture is tied, which creates a suture suspension between the abductor pollicis longus (APL) tendon and flexor carpi radialis (FCR) tendon and supports the metacarpal (MC) bone. An illustration of the suture between abductor pollicis longus tendon and flexor carpi radialis tendon is shown at the box.

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  Fig. 7 The trapezial space height line A and the 1st proximal phalangeal height line B.

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  Fig. 8 A 62-year-old female who was diagnosed with advanced carpometacarpal joint osteoarthritis in Eaton-Littler stage III. (A) preoperative radiographs, (B) postoperative radiographs, (C) last follow-up radiographs (22 months).

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