Thumb Basal Joint Arthroplasty Outcomes and Metacarpal Subsidence: A Prospective Cohort Analysis of Trapeziectomy with Suture Button Suspensionplasty versus Ligament Reconstruction with Tendon Interposition
Asif Ilyas, MD, Orthopaedics, Rothman Institute at Thomas Jefferson University, Philadelphia, PA and Owolabi Shonuga, MD, Rothman Institute at Thomas Jefferson University, Philadelphia, PA
Thumb carpometacarpal (CMC) joint arthroplasty is a common procedure in the surgical management of symptomatic thumb basal joint arthritis. Following trapeziectomy, a number of suspensionplasty techniques are often employed, but limited comparative evidence exists between these techniques. The central aim of this study is to prospectively compare the outcomes of two suspensionplasty techniques following trapeziectomy: suture button (TightRope) versus ligament reconstruction and tendon interposition (LRTI).
Prospective data was collected on 122 consecutive patients with Eaton stage III-IV thumb CMC arthritis who underwent open trapeziectomy and suspensionplasty. There were 53 LRTI and 59 TightRope suspensionplasties. Outcomes were measured using the Quick-Disability of the Arm, Shoulder and Hand (QuickDASH) questionnaire, Visual Analog Score (VAS) for pain, radiograph analysis, and lateral pinch strength. Patient demographic data and complications were also recorded.
Patients undergoing TightRope suspensionplasty had significantly higher trapeziometacarpal index (TMI), and thus less subsidence, than the LRTI group at 2-weeks [.224 vs .170 (p<.0001)] and 3-months [.173 vs .145 (p<.05)] post-operatively. TightRope suspensionplasty also had a significantly lower QuickDASH score at 2-weeks [64.7 vs 74.6 (p<.05)], 3-months [20.7 vs 32.5 (p<.05)], and 1-year post-op [7.57 vs 21.5 (p<.05)] compared to the LRTI group. However, there was no difference in VAS pain, lateral pinch strength, re-operation, or complications at any time point between groups.
Thumb CMC joint arthroplasty performed with a Tightrope suspensionplasty versus LRTI yielded short term improved resistance to subsidence, longer term greater improvement in clinical outcome by QuickDASH, and no difference in pain or complication rates.
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