Trapeziectomy and Suture-Button Suspensionplasty for Basilar Thumb Arthritis: Is It Enough to Prevent First Ray Subsidence?

Abstract

Introduction Trapeziectomy and suture-button suspensionplasty (SBS) are a novel option to treat end-stage trapeziometacarpal (TMC) osteoarthritis. Our purpose is to evaluate our outcomes with this technique and in this setting, with a minimum of 18 months of follow-up.

Materials and Methods Twenty-eight patients were included, operated between 2016 and 2018. We recorded demographic data, preoperative Eaton stage, follow-up and operative times. The patients completed the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire and tip pinch, key pinch, and grip strength were measured. First metacarpal subsidence was calculated, and postoperative complications were documented.

Results The average follow-up was 34 months. The mean QuickDASH was 32 at the final follow-up. The average strength results were 20 kg for grip, 3.6 kg for tip pinch, and 4.2 kg for key pinch. The rate of first ray subsidence was 10.7%. We encountered three complications: a hardware intolerance, a second metacarpal fracture, and a suture rupture. There was one reoperation to remove an implant.

Conclusion Trapeziectomy and SBS functional results are similar to other techniques, with less subsidence of the first ray and allowing for early mobilization and fast recovery. This procedure is a safe and promising option in the treatment of TMC osteoarthritis, with good medium-term outcomes.

Keywords

thumb - trapeziometacarpal joint - arthritis - trapeziectomy - suture-button suspensionplasty - hand - surgery - Mini TightRope

Publication History

Article published online:
16 November 2020

• References

• 1 DeGeorge Jr BR, Chawla SS, Elhassan BT, Kakar S. Basilar thumb arthritis: the utility of suture-button suspensionplasty. Hand (N Y) 2019; 14 (01) 66-72
• 2 Hooke AW, Parry JA, Kakar S. Mini TightRope fixation versus ligament reconstruction - tendon interposition for maintenance of post-trapeziectomy space height: a biomechanical study. J Hand Surg Am 2016; 41 (03) 399-403
• 3 Avant KR, Nydick JA, White BD, Vaccaro L, Hess AV, Stone JD. Basal joint osteoarthritis of the thumb: comparison of suture button versus abductor pollicis longus suspensionplasty. Hand (N Y) 2015; 10 (01) 80-84
• 4 Kapoutsis DV, Dardas A, Day CS. Carpometacarpal and scaphotrapeziotrapezoid arthritis: arthroscopy, arthroplasty, and arthrodesis. J Hand Surg Am 2011; 36 (02) 354-366
• 5 Parry JA, Kakar S. Dual Mini TightRope suspensionplasty for thumb basilar joint arthritis: a case series. J Hand Surg Am 2015; 40 (02) 297-302
• 6 Wajon A, Vinycomb T, Carr E, Edmunds I, Ada L. Surgery for thumb (trapeziometacarpal joint) osteoarthritis. In: Wajon A. ed. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd; 2015
• 7 Yao J, Lashgari D. Thumb basal joint: utilizing new technology for the treatment of a common problem. J Hand Ther 2014; 27 (02) 127-132
• 8 Burton RI, Pellegrini Jr VD. Surgical management of basal joint arthritis of the thumb. Part II. Ligament reconstruction with tendon interposition arthroplasty. J Hand Surg Am 1986; 11 (03) 324-332
• 9 Yao J, Song Y. Suture-button suspensionplasty for thumb carpometacarpal arthritis: a minimum 2-year follow-up. J Hand Surg Am 2013; 38 (06) 1161-1165
• 10 Weiss AC, Kamal RN, Paci GM, Weiss BA, Shah KN. Suture suspension arthroplasty for the treatment of thumb carpometacarpal arthritis. J Hand Surg Am 2019; 44 (04) 296-303
• 11 Yao J, Zlotolow DA, Murdock R, Christian M. Suture button compared with K-wire fixation for maintenance of posttrapeziectomy space height in a cadaver model of lateral pinch. J Hand Surg Am 2010; 35 (12) 2061-2065
• 12 Yao J, Cheah AEJ. Mean 5-year follow-up for suture button suspensionplasty in the treatment of thumb carpometacarpal joint osteoarthritis. J Hand Surg Am 2017; 42 (07) 569.e1-569.e11
• 13 Khalid M, Jones ML. Index metacarpal fracture after tightrope suspension following trapeziectomy: case report. J Hand Surg Am 2012; 37 (03) 418-422
• 14 Seetharaman M, Vitale MA, Desai K, Crowe JF. Extensor pollicis longus rupture after Mini TightRope suspensionplasty. J Wrist Surg 2016; 5 (02) 143-146
• 15 Graham JG, Rivlin M, Abboudi J, Lutsky K, Beredjiklian PK. Delayed, atraumatic index metacarpal fracture after trapeziectomy and suture-button suspensionplasty for thumb carpometacarpal osteoarthritis: a report of three cases. J Hand Surg Am 2019; 44 (04) 344.e1-344.e5
• 16 Sonoda LA, Jones NF. Failed suture button suspensionplasty of the thumb carpometacarpal joint salvaged using pyrocarbon arthroplasty. J Hand Surg Am 2017; 42 (08) 665.e1-665.e4
• 17 Mirza A, Mirza JB, Klingbeil L, Pavlik III JF, Muratori J, Thomas T. A modified suture suspension arthroplasty technique for the treatment of basal joint arthritis: short-to intermediate-term outcomes. Hand (N Y) 2020;
• 18 Vermeulen GM, Slijper H, Feitz R, Hovius SER, Moojen TM, Selles RW. Surgical management of primary thumb carpometacarpal osteoarthritis: a systematic review. J Hand Surg Am 2011; 36 (01) 157-169
• 19 Gray KV, Meals RA. Hematoma and distraction arthroplasty for thumb basal joint osteoarthritis: minimum 6.5-year follow-up evaluation. J Hand Surg Am 2007; 32 (01) 23-29
• 20 Vitale MA, Hsu CC, Rizzo M, Moran SL. Pyrolytic carbon arthroplasty versus suspensionplasty for trapezial-metacarpal arthritis. J Wrist Surg 2017; 6 (02) 134-143
• 21 Mohan A, Shenouda M, Ismail H, Desai A, Jacob J, Sarkhel T. Patient functional outcomes with trapeziectomy alone versus trapeziectomy with TightRope(®). J Orthop 2015; 12 (Suppl. 02) S161-S165
• 22 Roman PB, Linnell JD, Moore JB. Trapeziectomy arthroplasty with suture suspension: short- to medium-term outcomes from a single-surgeon experience. J Hand Surg Am 2016; 41 (01) 34-39.e1
• 23 Landes G, Gaspar MP, Goljan P, Jacoby SM, Bachoura A, Culp RW. Arthroscopic trapeziectomy with suture button suspensionplasty: a retrospective review of 153 cases. Hand (N Y) 2016; 11 (02) 232-237
• 24 Song Y, Cox CA, Yao J. Suture button suspension following trapeziectomy in a cadaver model. Hand (N Y) 2013; 8 (02) 195-200
• 25 Hozack BA, Fram B, Ilyas AM, Rivlin M, Liss FE, Jones CM. Optimal Position of the Suture Button Suspensionplasty (TightRope) for thumb basal joint arthritis. Hand (N Y) 2020;
• 26 Miller AJ, Jones CM, Martin DP. et al. Reliability of metacarpal subsidence measurements after thumb carpometacarpal joint arthroplasty. J Hand Microsurg 2018; 10 (01) 22-25
• 27 Szalay G, Scheufens T, Alt V, Boecker W, Schnettler R. Die operative Versorgung der therapierefraktären Rhizarthrose mittels Trapezektomie und Suspension des ersten Strahls mittels Mini TightRope®. Handchir Mikrochir Plast Chir 2014; 46 (03) 179-185
• 28 Shah RF, Zhang S, Li K, Baker L, Sox-Harris A, Kamal RN. Physical and occupational therapy use and cost after common hand procedures. J Hand Surg Am 2020; 45 (04) 289-297