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1st Carpometacarpal Arthroplasty with Ligamentous Reconstruction: A Long-Term Follow-Up
Mark Yaffe, MD; Bennet Butler; James Saucedo, MD, MBA; Daniel Nagle, MD
Northwestern Memorial Hospital, Chicago, IL

Purpose: The purpose of the present study is to evaluate a single surgeon's short, intermediate and long-term clinical, functional, and radiographic outcomes with a trapeziectomy with FCR suspension arthroplasty without tendon interposition (LRSA). This study is the longest and most comprehensive follow-up study evaluating the clinical, functional, and radiographic outcomes following LRSA.
Methods: 21 patients underwent 26 FCR suspension arthroplasties without tendon interposition by a single senior surgeon. All patients had Eaton stage III and IV CMC osteoarthritis. The PRWHE and Quick DASH were used to evaluate functional outcomes. A comprehensive strength and range of motion evaluation was performed to evaluate clinical outcomes. Plain radiographs at rest and with maximal pinch were performed to evaluate for arthroplasty space subsidence.
Results: The LRSA exhibited consistent clinical and functional outcomes throughout postoperative follow-up. As the average patient age and time from surgery increased, ROM and PRWHE scores stayed relatively constant, while lateral tip and tip pinch strength deteriorated with time. The LRSA prevented the proximal migration of the first metacarpal in all but one patient. No patients required arthroplasty with greater than 15 year follow-up.
Discussion/Conclusions: This study focused on the short, intermediate, and long-term clinical, functional, and radiographic outcomes following a trapeziectomy with FCR suspension arthroplasty without tendon interposition (LRSA) for treatment of advanced CMC osteoarthritis. At each time interval, patients treated with LRSA continued to exhibit strength, range of motion, and patient satisfaction, and functional outcomes that were comparable or superior to common alternative arthroplasty techniques described in the literature. This study is the longest and most comprehensive follow-up study of its kind. Our study confirms that the LRSA procedure can generate satisfactory results at mid to long-term follow-up without the need for revision surgery.


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