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Optimizing Carpometacarpal Arthroplasty of the Thumb: A Prospective Clinical Trial Comparing Suture Suspension to Ligament Reconstruction and Tendon Interposition
Debra A Bourne, MD; Ian Chow, MD; Dann Laudermilch, MD; Benjamin K Schilling, MS; Wesley Sivak, PhD, MD; William Hagberg, MD; Marshall Balk, MD; Glenn Buterbaugh, MD; Joseph Imbriglia, MD; John Fowler, MD
University of Pittsburgh Medical Center Department of Plastic Surgery
2020-02-15
Presenter: Ian Chow, MD
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. The program director is responsible for making a statement within the confines of the box below specific to how much of the work on this project represents the original work of the resident. All authors/submitters of each abstract should discuss this with their respective program director for accurate submission of information as well as the program director's approval for inclusion of his/her electronic signature.
Director Name: Vu T. Nguyen, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Hand
Background: CMC arthroplasty is the most commonly performed surgical reconstruction for arthritis in the upper extremity. The purpose of this study is to compare outcomes between ligament reconstruction and tendon interposition (LRTI) and suture suspension arthroplasty to determine if one is superior.
Methods: Following IRB approval, 38 consecutive patients undergoing CMC arthroplasty for basilar thumb osteoarthritis were enrolled by four senior, fellowship trained surgeons; two of whom prefer the LRTI technique and two who routinely perform suture suspension arthroplasty. Outcome measures were recorded including: first metacarpal subsidence measured on radiographs, thumb range of motion, pinch and grip strength, functionality assessed through the Disability of Arm, Shoulder and Hand (DASH) and Michigan Hand Questionnaires (MHQ), and pain measured on a 10-point Visual Analog Scale (VAS).
Results: Both techniques are effective at reducing pain with a decrease from baseline to 6-weeks post-procedure. The suture suspension technique resulted in greater thumb abduction at 6-weeks compared to LRTI (p=0.018). LRTI resulted in more limited opposition at 6-weeks post-procedure (p=0.002). There was no significant difference in thumb extension, grip or pinch strength. Both techniques improved functionality from baseline to 6-weeks post-operative based on the MHQ (LRTI, p=0.037; suture suspension, p=0.012). There was significant radiographic subsidence in both groups at 2-weeks post-operative (p<0.001), however, subsidence was significantly less for suture suspension compared to LRTI (p=0.005).
Conclusions: LRTI and suture suspension arthroplasty techniques are equally effective for improving pain and functionality. Both techniques are subject to some subsidence of the first metacarpal.
