Suture Suspension Arthroplasty for the Treatment of Thumb Carpometacarpal Arthritis

Weiss, Arnold‐Peter C.; Kamal, Robin N.; Paci, Gabrielle M.; Weiss, Barrett; Shah, Kalpit N.

doi:10.1016/j.jhsa.2019.02.005

Cited by 29 publications

(35 citation statements)

References 29 publications

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“…3). This reconstruction has been suggested as having merit based on its attributes such as being a less-invasive as well as a faster procedure than using a prosthetic replacement or LRTI 18 ; however, the suture slings were probably unable to prevent the proximal migration of the first metacarpal during active wrist motions, thereby resulting in higher forces in FE. 30 A reduction in APL force following prosthetic replacement, despite using a silicone implant of the same size for all specimens, could suggest a partial restoration of the APL insertion and tendon moment arm by filling the trapezial void; however, there was an associated increase in FCR force, especially in FE (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…14 However, studies have questioned the success of LRTI 15e17 and have proposed a suture suspension arthroplasty procedure as a faster and less-invasive alternative to harvesting a tendon graft. 18 Notwithstanding the growing popularity of LRTI to treat trapeziometacarpal osteoarthritis, each of the commonly performed surgical interventions has associated advantages and limitations. Despite the reported shortcomings of trapeziectomy, 4,5 in vivo studies based on the dimensions of the trapezial gap, thumb pain, and thumb strength 13,19 question the need of surgical reconstructions posttrapeziectomy.…”

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confidence: 99%

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The Effect of Surgical Treatments for Trapeziometacarpal Osteoarthritis on Wrist Biomechanics: A Cadaver Study

Shah

Middleton

Gurdezi

et al. 2020

The Journal of Hand Surgery

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Purpose Studies have shown the effects of surgical treatments for trapeziometacarpal osteoarthritis on thumb biomechanics; however, the biomechanical effects on the wrist have not been reported. This study aimed to quantify alterations in wrist muscle forces following trapeziectomy with or without ligament reconstruction and replacement.Methods A validated physiological wrist simulator replicated cyclic wrist motions in cadaveric specimens by applying tensile loads to 6 muscles. Muscle forces required to move the intact wrist were compared with those required after performing trapeziectomy, suture suspension arthroplasty, prosthetic replacement, and ligament reconstruction with tendon interposition (LRTI).Results Trapeziectomy required higher abductor pollicis longus forces in flexion and higher flexor carpi radialis forces coupled with lower extensor carpi ulnaris forces in radial deviation. Of the 3 surgical reconstructions tested post-trapeziectomy, wrist muscle forces following LRTI were closest to those observed in the intact case throughout the range of all simulated motions. ConclusionsThis study shows that wrist biomechanics were significantly altered following trapeziectomy, and of the reconstructions tested, LRTI most closely resembled the intact biomechanics in this cadaveric model. Clinical relevance Trapeziectomy, as a standalone procedure in the treatment of trapeziometacarpal osteoarthritis, may result in the formation of a potentially unfilled trapezial gap, leading to higher wrist muscle forces. This biomechanical alteration could be associated with clinically important outcomes, such as pain and/or joint instability.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

The Effect of Surgical Treatments for Trapeziometacarpal Osteoarthritis on Wrist Biomechanics: A Cadaver Study

Shah

Middleton

Gurdezi

et al. 2020

The Journal of Hand Surgery

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“…In addition to APL suspensionplasty and LRTI, a variety of other techniques for the surgical management of basal joint arthritis have been demonstrated to effectively relieve pain—all centered around removal of the trapezium. 17-29 This includes trapeziectomy alone, 17-19 hematoma distraction arthroplasty (trapeziectomy with temporary K-wire fixation), 20,21 suture suspensionplasty between the APL and FCR tendons, 22,23 suture button suspensionplasty between the first and second metacarpals, 24,25 and allograft and xenograft interpositions. 26,27 The use of multiple types of implant arthroplasties has also been reported; however, long-term complication rates have limited their popularity thus far.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Abductor Pollicis Longus Suspensionplasty Compared to Ligament Reconstruction and Tendon Interposition

Satteson

Driscoll

Khan

et al. 2020

Hand (New York, N,Y.)

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Background: Multiple surgical techniques are described for basal joint osteoarthritis. This study compares clinical outcomes and patient satisfaction with trapeziectomy and abductor pollicis longus (APL) suspensionplasty compared to trapeziectomy with ligament reconstruction and tendon interposition (LRTI) when performed by 2 fellowship-trained hand surgeons. Methods: A retrospective review of 51 consecutive patients undergoing APL suspensionplasty (53 hands) was performed. With this technique, a distally based APL slip is brought through and sewn to the flexor carpi radialis (FCR). The remaining APL is placed in the trapeziectomy void. This technique was compared to 151 patients (166 hands) who underwent LRTI using the FCR tendon. Outcomes assessed included postoperative pain relief, grip and pinch strength, complications, and need for reoperation. Two-tailed, Fisher’s exact test was used for data analysis. Results: APL suspensionplasty resulted in postoperative pain relief in 92.5% (n = 49) compared to 94.0% (n = 156) with LRTI ( P = .758). Mean postoperative grip and pinch strengths with APL suspensionplasty were 41.2 and 10.4 kg, respectively. With LRTI, average grip strength was 42.0 kg, and pinch was 10.1 kg. Both techniques were well tolerated with minimal complications. In the APL group, 1 patient had a postoperative infection requiring drainage. Among the LRTI cases, 1 wound dehiscence required closure, and 2 minor postoperative wound infections resolved with oral antibiotics. Mean follow-up time among APL suspensionplasty patients was 3.3 months compared to 8.4 months following LRTI. Conclusions: APL suspensionplasty is a safe, effective procedure which provides similar pain relief and functional outcomes compared to LRTI.

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“…1 Recently described procedures mix trapeziectomy with suspensionplasty between the first and second metacarpals to prevent index subsidence into the newly formed TMC space, either using a suture-button 7,9 or just a high-strength orthopaedic suture. 10 In our approach, we perform a trapeziectomy followed by suspension of the first and second metacarpals using a single strand of a nonabsorbable suture with Mini TightRope suture button. This technique offers similarly good results when compared with previously described techniques when it comes to pain reduction, restoration of mobility, and strength.…”

Section: Introductionmentioning

confidence: 99%

Trapeziectomy and Suture-Button Suspensionplasty for Basilar Thumb Arthritis: Is It Enough to Prevent First Ray Subsidence?

Ferrão

Morais

Marques

et al. 2023

Journal of Hand and Microsurgery

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Introduction Trapeziectomy and suture-button suspensionplasty (SBS) are a novel option to treat end-stage trapeziometacarpal (TMC) osteoarthritis. Our purpose is to evaluate our outcomes with this technique and in this setting, with a minimum of 18 months of follow-up. Materials and Methods Twenty-eight patients were included, operated between 2016 and 2018. We recorded demographic data, preoperative Eaton stage, follow-up and operative times. The patients completed the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire and tip pinch, key pinch, and grip strength were measured. First metacarpal subsidence was calculated, and postoperative complications were documented. Results The average follow-up was 34 months. The mean QuickDASH was 32 at the final follow-up. The average strength results were 20 kg for grip, 3.6 kg for tip pinch, and 4.2 kg for key pinch. The rate of first ray subsidence was 10.7%. We encountered three complications: a hardware intolerance, a second metacarpal fracture, and a suture rupture. There was one reoperation to remove an implant. Conclusion Trapeziectomy and SBS functional results are similar to other techniques, with less subsidence of the first ray and allowing for early mobilization and fast recovery. This procedure is a safe and promising option in the treatment of TMC osteoarthritis, with good medium-term outcomes.

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Suture Suspension Arthroplasty for the Treatment of Thumb Carpometacarpal Arthritis

Cited by 29 publications

References 29 publications

The Effect of Surgical Treatments for Trapeziometacarpal Osteoarthritis on Wrist Biomechanics: A Cadaver Study

The Effect of Surgical Treatments for Trapeziometacarpal Osteoarthritis on Wrist Biomechanics: A Cadaver Study

Efficacy of Abductor Pollicis Longus Suspensionplasty Compared to Ligament Reconstruction and Tendon Interposition

Trapeziectomy and Suture-Button Suspensionplasty for Basilar Thumb Arthritis: Is It Enough to Prevent First Ray Subsidence?

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