Suture Suspension Arthroplasty for Thumb Carpometacarpal Arthritis Reconstruction: 12- to 14-Year Follow-up

Abstract

Background Many surgical procedures have been described for the treatment of thumb carpometacarpal (CMC) joint osteoarthritis, with significant variation. To date, none has proven to be superior. The purpose of this study was to report long-term follow-up results of suture suspension arthroplasty (SSA). Methods The SSA technique uses a single incision, trapeziectomy, and an intra-articular suture suspension sling anchored into the insertions of the flexor carpi radialis (FCR) and abductor pollicis longus (APL), which serves to stabilize the base of the thumb metacarpal, correct subluxation deformity, and maintain arthroplasty space. Ninety of 153 SSA reconstructions (59% recall) were evaluated at long-term follow-up (mean, 12.6 years). Data were analyzed for functional outcomes, including preoperative and postoperative grip and pinch strength, radiographs, complications, and postoperative Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores. Results The mean age at date of surgery was 61.7 ± 7.6 years (82% women). Significant improvement was noted in grip strength (preoperative mean, 25.0 kg; postoperative mean, 28.0 kg; P < .0001), key pinch (preoperative, 4.2 kg; postoperative, 5.1 kg; P < .0001), and tip pinch (preoperative, 2.9 kg; postoperative, 3.6 kg; P < .0001). Radiographic subsidence averaged 35% (0-90). Postoperative QuickDASH scores (mean, 6.6; range, 0-50) revealed good to excellent pain relief and function. One revision was performed, and postoperative FCR rupture occurred in 3 reconstructions. Conclusions The SSA technique for thumb CMC arthritis reconstruction yields good to excellent long-term clinical outcomes. Potential advantages of the SSA include short operative time, a single incision, minimal cost, and no need for tendon harvesting, pin fixation, or implantable hardware.

Suture suspension sling arthroplasty in thumb carpometacarpal joint arthritis: A case series

“…Del Signore JL et al studied 153 patients who underwent suture suspension arthroplasty and trapeziectomy. Their study also showed good results with significantly improved grip strength, key pinch, and functional outcome [ 9 ].…”

“…Patients with CMC arthritis, regardless of the etiology, were confirmed by performing plain X-ray radiography. The surgical-suturing technique used by Delsignode and Accardi was described in 2009 and later modified by Arnold Peter C Weiss [ 2 , 9 ]. The procedure is performed with the patient under general anesthesia and first draped in a sterile condition.…”

“…Suture sling arthroplasty requires fewer donor sites from tendon transfer complications, reduces surgical time, decreases the infection risk, and is less invasive. Thumb metacarpal stabilization can still be achieved at the same time [ 2 , 9 ].…”

Suture suspension arthroplasty technique for basal joint arthritis reconstruction

“…Radiographic findings suggestive of BJA include joint space narrowing, subchondral sclerosis, osteophyte formation, and subluxation or dislocation of the thumb metacarpal relative to the trapezium. (Satria et al, 2023) [5] [2] .…”

“…Several surgical techniques have been developed to address BJA, each with its unique principles, indications, and outcomes. (DelSignore et al, 2023) [2] . Among the traditional surgical approaches, trapeziectomy stands out as a widely accepted method for BJA reconstruction.…”