Surgical Treatment of Thumb Carpometacarpal Joint Arthritis: A Single Institution Experience from 1995–2005

Abstract

There are numerous techniques for the surgical management of thumb carpometacarpal (CMC) joint arthritis. The four senior authors of this study employ three such techniques: trapeziectomy with hematoma distraction arthroplasty, hemitrapeziectomy with osteochondral allograft, and ligament reconstruction tendon interposition (LRTI). This study examines the three commonly utilized procedures at a single institution. This study examines the 10-year experience from 1995-2005 with a minimum 3-month follow-up. Disabilities of the arm, shoulder, and hand (DASH) scores, pre-and postoperative pinch strength, and operative time were examined. After approval from the institutional review board of our institution was obtained, all patients treated surgically by three of the senior authors were contacted via mail and phone. Each patient was asked to complete and return a DASH questionnaire. Of the 115 patients treated during that period, 60 participated in this study. Each patient's final postoperative pinch measurement was obtained from occupational therapy and clinic records. This pinch strength was compared to the preoperative pinch and contralateral pinch strength. Lastly, the total operative time for each procedure was obtained from the operative record. The only significant finding in this study was a shorter mean operative time with the trapeziectomy group (76.90 min) and osteochondral allograft group (90.45 min) when compared to the LRTI group (139.00 min; p = 0.001 and p = 0.001, respectively). We found no significant difference between groups in terms of DASH score and pinch strength. There was no difference between the techniques in terms of postoperative pinch strength and patient satisfaction measured by DASH scores. The operative times for trapeziectomy and hematoma interposition as well as the osteochondral allograft were significantly shorter than that of the LRTI. This presents further evidence that potentially, "less is more" in the treatment of thumb CMC arthritis. We used a retrospective study design to evaluate potential differences between the three surgical techniques described above, therapeutic, levels III-IV.

Biomechanical Comparison of Suture-Button Suspensionplasty and LRTI for Basilar Thumb Arthritis

“…3,9 Comparative studies have shown no significant long-term difference in outcomes among these techniques, 18,[29][30][31] aside from a lower complication rate 30,31 and shorter operative time with trapeziectomy alone. 20 The use of a suture-button suspensionplasty (SBS) with trapeziectomy has grown in popularity. 6,24,35,36 Advocates of this technique cite safety, ease of use, early mobilization, and good early results.…”

Dual Mini TightRope Suspensionplasty for Thumb Basilar Joint Arthritis: A Case Series

“…Currently, no single procedure has shown a clear benefit over others. 2,4,5 TightRope (Arthrex, Naples, FL) TMC suspensionplasty has been proposed as an alternative to Kirschner wire fixation that may allow for earlier mobilization in the hope of preventing stiffness and avoiding Kirschner wire complications such as pin track infection. 6,7 Yao et al 8 demonstrated that compared with Kirschner wire fixation, TightRope suspensionplasty has equivalent strength and ability to maintain trapezial space after repeated loading cycles.…”

Early outcomes of arthroplasty of the first carpometacarpal joint using pyrocarbon spherical implants

“…Davis and Pace (20) performed the procedure on 46 patients with an average DASH score of 37 at one year postoperatively. In another study evaluating an institution's 10-year experience, the mean DASH score was 19.26±12.94 (21).…”