Most surgeons advocate trapeziectomy, ligament reconstruction, and tendon interposition arthroplasty for the treatment of thumb basal joint osteoarthritis. However, the harvesting and weaving of autologous tendon is time consuming and thought to create scarring, alter wrist kinetics, and prolong recovery. The propose of this article was to describe the senior author’s new method of arthroplasty using suture anchor suspensionplasty and cadaveric fascia lata interposition.
A retrospective study of 46 thumb carpometacarpal joint arthroplasties was conducted. Total (n =17) or partial (n= 29) trapeziectomy was performed on patients with advanced osteoarthritis (Eaton stage III and IV) followed by Mitek suture anchor suspension of the first to the second metacarpal and cadaveric fascia lata interposition. Surgical time was estimated to be between 35-50 minutes. Average follow-up was 4 years. In the short term, 93 percent of thumbs had excellent pain relief, whereas in the long term, pain relief increased to 96 percent. In the short term, 87 percent of cases showed high satisfaction, but this increased to 93 percent in the long term. Average key pinch and tip pinch improvements were 1.5 kg (76 percent improvement) and 2.0 kg (81 percent improvement), respectively. Three patients had minor complications. The authors conclude that this technique is a reliable, effective, expeditious, and obviates the need for tendon harvest.
This article adds yet another technique to the hand surgeon’s armamentarium of procedures to treat osteoarthritis of the thumb CMC joint. The reported results are comparable to other long-term outcomes reports studying the LRTI and hematoma distraction arthroplasty. The major advantage of this procedure is that it obviates the harvesting of an adjacent tendon and it is expeditious. The major disadvantage stems from the use of cadaveric tissues and the theoretical infectious disease transmission liability. Furthermore, there is the associated added cost of $500 for the suture anchor and allograft. However, this may be partially offset by a shorter operative time. A prospective randomized trial of the various CMC arthroplasty techniques is needed to definitively determine which procedure is best.