Lessons Learned: Trapeziectomy and Suture Suspension Arthroplasty for Thumb Carpometacarpal Osteoarthritis

Abstract

In this study, we describe refinements of an accepted technique made by a single surgeon for trapeziectomy and suture suspension arthroplasty for thumb carpometacarpal (CMC) osteoarthritis after 220 cases over 4 years. Results are derived from 77 patients who underwent treatment using this technique comparing postoperative results with preoperative assessment and had sufficient data for inclusion. The surgical technique is described, including tips and modifications to avoid known possible complications. All patients in this study had advanced Eaton stage III or IV osteoarthritis. Grip strength and key pinch showed statistically significant improvement, and the improvement in palmar pinch approached significance. Pain scores were significantly decreased with over 50% of the patients rating their pain at 0 postoperatively. The overall complication rate was very low, and improvements in technique were made to mitigate future occurrence. This surgical technique for the treatment of thumb CMC arthritis achieved pain relief and recreated ligamentous support of the base of the first metacarpal to resist proximal migration after trapeziectomy, providing an increase in grip strength and key pinch with return of range of motion early in the postoperative period. Refinements on this technique through a large volume single surgeon experience provide technical tips for optimizing outcomes.

Keywords: carpometacarpal; ligament reconstruction and tendon interposition; mini tight rope fixation; thumb arthritis.

Fig. 1

Placement of suture button anchors. (A) Suture button shown in its preferred position (red arrow) on the radial side of the first metacarpal base just volar to the ridge, and the target spot is visualized on the proximal second metacarpal. Inset bottom right shows enlarged view. ( B ) The suture button anchor is visualized in its preferred position (red arrow) on the ulnar side of the second metacarpal. Inset bottom left shows enlarged view.

Fig. 2

Postoperative radiographs following suture suspension arthroplasty. PA (A) and lateral ( B ) radiographs taken after suture suspension arthroplasty show button anchor placement and positioning of the suspension. Note the small articular facet at the base of the second metacarpal in the PA view can be a source of pain if the first metacarpal is suspended too distally. PA, posterior approach.