American Association for Hand Surgery
Theme: Beyond Innovation

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A Prospective Cohort Analysis of 3 Thumb CMC Arthroplasty Techniques
Owolabi Shonuga, MD; Asif Ilyas, MD
Rothman Institute at Thomas Jefferson University, Philadelphia, PA

INTRODUCTION:
Thumb basal joint or carpometacarpal (CMC) joint arthroplasty is a common procedure used to manage symptomatic thumb base arthritis. Following trapeziectomy, a number of suspensionplasty techniques are utilized, but limited comparative evidence exists between these techniques. The aim of this study was to prospectively assess the effectiveness of three suspensionplasty techniques following complete open trapeziectomy: suturebutton (TightRope), abductor pollicis longus (APL), and flexor carpi radialis (FCR) suspensionplasty relative to outcomes and complication rates.
METHODS:
Prospective data was collected on 144 consecutive patients with Eaton stage III-IV thumb CMC arthritis who underwent open trapeziectomy and suspensionplasty. There were 35 APL, 43 FCR, and 66 Mini TightRope suspensionplasties. We recorded outcome measures using Quick-Disability of the Arm, Shoulder and Hand (QuickDASH) questionnaires, Visual Analog Score (VAS) for pain, and Lateral pinch strength. Patient demographic data and complications were also documented.
RESULTS:
The mean age of all patients was 62.4 years. The mean QuickDASH score for the TightRope group (23) was significantly lower than that of APL (28) and FCR (35) (p = .03) at 3-month follow-up. However, by the 1-year post-operative visit this difference normalized. There was no difference in lateral pinch strength and VAS pain scores at any point between the three suspensionplasty groups. There were also no re-operations or fractures in any groups at all time points.
CONCLUSION:
Thumb CMC TightRope suspensionplasty following trapeziectomy for thumb basal joint arthritis yielded higher QuickDASH outcomes through the first 3 months post-operatively. These differences normalized by the 1 year post-operative visit. There were no difference in complications and no re-operations in any group.


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