Suspensionplasty for Revision Thumb Carpometacarpal Osteoarthritis Surgery: Comparing Suture Button Suspensionplasty to Ligament Reconstruction and Tendon Interposition
Evan M Guerrero, MD1; Andrew J Grier, MD1; Harrison R Ferlauto, BS1; Elizabeth P. Wahl, MD2; Marc J. Richard, MD3; David S. Ruch, MD2
1Duke University Health System, Durham, NC, 2Duke University, Durham, NC, 3Duke University Medical Center, Durham, NC
Thumb carpometacarpal (CMC) osteoarthritis (OA) is a common disorder, with as many as 91% of patients over the age of 80 demonstrating radiographic evidence of trapeziometacarpal arthrosis. Many surgical procedures have been described to successfully treat this condition, including complete or partial trapeziectomy with or without ligament interposition or suspension, and arthrodesis. Metacarpal suspension has been described using abductor pollicis longus (APL), flexor carpi radialis (FCR) tendon, allograft, Kirschner wire (K-Wire), and most recently suture button(s). To date, no one procedure has been demonstrated to be definitively superior to the others. Suture button suspensionplasty (SBS) has been demonstrated to more effectively resist metacarpal subsidence than ligament reconstruction and tendon interposition (LRTI) in a cadaver model. SBS has also been demonstrated to have a shorter operative time than APL suspensionplasty, and allows for mobilization as early as 10 days postoperatively. SBS has demonstrated favorable outcomes at five years in primary cases, but it has not been validated in revision of previous thumb CMC OA surgery.
Materials & Methods
A retrospective chart review was performed of patients who underwent suspensionplasty after failure of previous thumb CMC OA surgery. Eighteen patients were included, with nine patients undergoing SBS and nine undergoing LRTI. The primary outcomes were presence of a complication, change in Visual Analogue Scale (VAS), and operative time.
The eighteen patients had an average follow up of 11.1 months (1.5-38 months), with an average follow up of 7.78 months in the SBS group and 14.4 months in the LRTI group. Revision was performed after failed fusion, LRTI, SBS, arthroplasty, and ligament/capsule plication. There were no complications in the SBS group. In the LRTI group, two patients had symptomatic subsidence with one being offered revision surgery and the other given serial injections. The SBS group had an average improvement of VAS of 2.89 points (p=0.0133), and LRTI group had an average improvement of 1.55 (p=0.168), but no significant difference was found between the change in VAS between the groups (p=0.263). Average operative time was 86.3 minutes in the SBS group, compared to 121 minutes in the LRTI group (p=0.0092)
SBS is a safe and effective surgical option in revision thumb CMC OA surgery, providing pain relief and low complication rates at short term follow up. SBS demonstrates significantly lower operative times compared to LRTI in revision thumb CMC OA surgery.
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