OUTCOMES FOLLOWING “DOUBLE KNOT” SUSPENSION ARTHROPLASTY FOR BASAL JOINT ARTHRITIS OF THE THUMB
Abstract
Background: Various surgical options used in the treatment of osteoarthritis of the basal joint of the thumb that are refractory to non-surgical management. This study was conducted to provide short term functional outcomes using the mentioned technique in treating basal joint arthritis of the thumb. Methods: We treated basal joint arthritis of the thumb by trapeziumectomy and volar oblique ligament reconstruction using flexor carpi radialis tendon and “suspension” interposition arthroplasty using the entire tendon split along its length and tied as a double knot at the base of the thumb metacarpal. Through a questionnaire based survey, we reviewed 24 thumbs in 24 patients with basal joint arthritis of the thumb who were followed up with the hand therapist. Postal questionnaires were sent to these patients to record DASH scores and satisfaction. Results: The mean time from surgery to discharge by the hand therapist following rehabilitation was 10 weeks. The DASH score averaged 25 points at 12 weeks postoperatively. There was statistical significance (p-value=0.0001) between the DASH score compared with time spent with the hand therapist. The postoperative net difference in grip strength and pinch grip compared with non-operated had was 9 kg and 3 kg respectively and the net difference in web span was 2 cm. Conclusion: We suggest this technique of “suspension” arthroplasty is a safe and effective method in treating basal joint arthritis of the thumb with good short-term functional outcomes and minimal complications.Keywords: Basal Joint Arthritis, Trapeziumectomy, Volar Oblique Ligament Reconstruction, “Suspension” Interposition Arthroplasty, DASHReferences
Burton RI. Basal joint arthritis. Fusion, implant, or soft tissue reconstruction? Orthop Clin North Am 1986;17(3):493–503.
Burton RI, Margles SW, Lunseth PA. Small-joint arthrodesis in the hand. J Hand Surg Am 1986;11(5):678–82.
De Smet L, Vaes F, Van Den Broecke J. Arthrodesis of the trapeziometacarpal joint for basal joint osteoarthritis of the thumb: the importance of obtaining osseous union. Chir Main 2005;24(5):222–4.
Lutonsky M, Pellar D. Arthrodesis of the carpometacarpal joint of the thumb. Acta Chir Orthop Traumatol Cech 2006;73(5):345–9.
Pustisek B. Arthrodesis of the basal joint of the big toe. Z Orthop Ihre Grenzgeb 1973;111(4):465–6.
Li YK, White C, Ignacy TA, Thoma A. Comparison of trapeziectomy and trapeziectomy with ligament reconstruction and tendon interposition: a systematic literature review. Plast Reconstr Surg 2011;128(1):199–207.
Lins RE, Gelberman RH, McKeown L, Katz JN, Kadiyala RK. Basal joint arthritis: trapeziectomy with ligament reconstruction and tendon interposition arthroplasty. J Hand Surg Am 1996;21(2):202–9.
Minami A, Iwasaki N, Kutsumi K, Suenaga N, Yasuda K. A long-term follow-up of silicone-rubber interposition arthroplasty for osteoarthritis of the thumb carpometacarpal joint. Hand Surg 2005;10(1):77–82.
Badia A, Sambandam SN. Total joint arthroplasty in the treatment of advanced stages of thumb carpometacarpal joint osteoarthritis. J Hand Surg Am 2006;31(10):1605–14.
De Smet L, Van Meir N, Verhoeven N, Degreef I. Is there still a place for arthrodesis in the surgical treatment of basal joint osteoarthritis of the thumb? Acta Orthop Belg 2010;76(6):719–24.
Ghavami A, Oishi SN. Thumb trapeziometacarpal arthritis: treatment with ligament reconstruction tendon interposition arthroplasty. Plast Reconstr Surg 2006;117(6):116e–128e.
Burton RI, Pellegrini VD,Jr. Surgical management of basal joint arthritis of the thumb. Part II. Ligament reconstruction with tendon interposition arthroplasty. J Hand Surg Am 1986;11(3):324–32.
Nylen S, Johnson A, Rosenquist AM. Trapeziectomy and ligament reconstruction for osteoarthrosis of the base of the thumb. A prospective study of 100 operations. J Hand Surg Br 1993;18(5):616–9.
Tomaino MM, Pellegrini VD,Jr, Burton RI. Arthroplasty of the basal joint of the thumb. Long-term follow-up after ligament reconstruction with tendon interposition. J Bone Joint Surg Am 1995;77(3):346–55.
Avisar E, Wasrbrout Z, Lin E, Agashi M. The thumb in agony--osteoarthritis of the thumb. Harefuah 2011;150(10):797–800.
Ho PK, Jacobs JL, Clark GL. Trapezium implant arthroplasty: evaluation of a semiconstrained implant. J Hand Surg Am 1985;10(5):654–60.
Salem H, Davis TR. Six year outcome excision of the trapezium for trapeziometacarpal joint osteoarthritis: is it improved by ligament reconstruction and temporary Kirschner wire insertion? J Hand Surg Eur Vol 2012;37(3):211–9.
Heyworth BE, Lee JH, Kim PD, Lipton CB, Strauch RJ, Rosenwasser MP. Hylan versus corticosteroid versus placebo for treatment of basal joint arthritis: a prospective, randomized, double-blinded clinical trial. J Hand Surg Am 2008;33(1):40–8.
Burton RI, Pellegrini VD, Jr. Surgical management of basal joint arthritis of the thumb. Part II. Ligament reconstruction with tendon interposition arthroplasty. J Hand Surg Am 1986;11(3):324–32.
Wong TC, Ip FK. A modified technique of interpositional arthroplasty in treating the Basal joint arthritis of the thumb in a Chinese population. Hand Surg 2009;14(2-3):83–7.
De Smet L, Sioen W, Spaepen D, van Ransbeeck H. Treatment of basal joint arthritis of the thumb: trapeziectomy with or without tendon interposition/ligament reconstruction. Hand Surg 2004;9(1):5–9.
Yang SS, Weiland AJ. First metacarpal subsidence during pinch after ligament reconstruction and tendon interposition basal joint arthroplasty of the thumb. J Hand Surg Am 1998;23(5):879–83.
Werner FW, Short WH, Palmer AK, Sutton LG. Wrist tendon forces during various dynamic wrist motions. J Hand Surg Am 2010;35(4):628–32.
Beall DP, Ritchie ER, Campbell SE, Tran HN, Ingari JV, Sanders TG, et al. Magnetic resonance imaging appearance of the flexor carpi radialis tendon after harvest in ligamentous reconstruction tendon interposition arthroplasty. Skeletal Radiol 2006;35(3):144–8.
Koh WI, Lim BH. Soft Tissue Complications Following Kirschner Wire Fixation for Fusion of Basal Joint Arthritis. Hand Surg 1999;4(2):197–202.
Bodin ND, Spangler R, Thoder JJ. Interposition arthroplasty options for carpometacarpal arthritis of the thumb. Hand Clin 2010;26(3):339–50.
University U. Postoperative Rehabilitation Following Trapeziectomy and Ligament Reconstruction Tendon Interposition: a Prospective, Randomized Multi-center Study. November 5, 2012; Available at: http://clinicaltrials.gov/show/NCT01425034, August 22, 2011
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