A Modified Suture Suspension Arthroplasty Technique for the Treatment of Basal Joint Arthritis: Short- to Intermediate-Term Outcomes

Hand ◽  
2020 ◽  
pp. 155894471988666 ◽  
Author(s):  
Ather Mirza ◽  
Justin B. Mirza ◽  
Laura Klingbeil ◽  
Joseph F. Pavlik ◽  
Jonathan Muratori ◽  
...  
Keyword(s):  
Contralateral Side ◽  
Pinch Strength ◽  
Dash Score ◽  
Radiographic Images ◽  
Basal Joint ◽  
Thumb Carpometacarpal ◽  
Relationship Of ◽  
Joint Arthritis ◽  
Suture Suspension

Background: To present a retrospective study on the outcomes of a modified version of suture suspension arthroplasty with trapeziectomy on patients with thumb basal joint arthritis and to evaluate the relationship between the degree of subsidence and functional outcome. Methods: We performed a chart review on 67 patients (75 thumbs) who were surgically treated for thumb carpometacarpal osteoarthritis with trapeziectomy and suture suspension arthroplasty from May 2010 to May 2016. Outcome measures included Disabilities of the Arm, Shoulder and Hand (DASH), grip strength, lateral/precision pinch strength, range of motion, and return to work/resumption of usual activities. Radiographic images were used to measure first metacarpal subsidence into the trapezial space. Results: Clinical outcomes were satisfactory, showing an initial postoperative DASH score of 45.94, which decreased to 27.93 at 6 months postoperatively and to 19.69 at 1 year postoperatively. Radiographic images revealed a mean first metacarpal subsidence of 39% compared with the preoperative images. Grip and pinch strengths showed steady improvement from initial postoperative to final follow-up visits, resulting in 90% recovery of gross grasp, 77% recovery of lateral pinch, and 79% recovery of precision pinch compared with the contralateral side. Conclusions: Our study has found that suture suspension arthroplasty with trapeziectomy is an effective treatment for thumb basal joint arthritis. Suture suspension arthroplasty allows for short immobilization time, avoids tendon sacrifice, avoids anchor use, and leaves a cosmetically appealing scar. Furthermore, a relationship of any significance between postoperative first metacarpal subsidence and functional outcomes does not appear.

ARTHROSCOPIC EVALUATION AND TREATMENT BY TENDON INTERPOSITIONAL ARTHROPLASTY OF FIRST CARPOMETACARPAL JOINT ARTHRITIS

Hand Surgery ◽  
2007 ◽  
Vol 12 (01) ◽  
pp. 35-39 ◽  
Author(s):  
L. Pegoli ◽  
C. Parolo ◽  
T. Ogawa ◽  
S. Toh ◽  
G. Pajardi
Keyword(s):  
Pinch Strength ◽  
Carpometacarpal Joint ◽  
Thumb Carpometacarpal Joint ◽  
Mayo Score ◽  
Basal Joint ◽  
Palmaris Longus Tendon ◽  
Thumb Carpometacarpal ◽  
Tendon Interposition ◽  
Joint Arthritis

Basal joint arthritis of the thumb is usually seen in females beginning from the fourth and fifth decades. In the last two decades, arthroscopic techniques have brought new chances of diagnosis and treatment for this condition. In this paper, the authors describe the indications and their experience concerning arthroscopic hemitrapezectomy and tendon interposition using the palmaris longus tendon. A series of 16 patients with a maximum follow-up of 12 months is analysed. All of the 16 patients were followed and assessed with grasp strength, pinch strength, DASH and MAYO evaluation score both pre- and post-operatively at 12 months follow-up. According to the MAYO score, there were six excellent results, six good, three fair and one poor. No complications occurred. According to our preliminary results, this procedure with the proper indications gives a valid option for the treatment of thumb carpometacarpal joint arthritis in stages I and II according to Eaton's classification.

Trapeziometacarpal narrow pseudarthrosis: a new surgical technique to treat thumb carpometacarpal joint arthritis

2012 ◽  
Vol 38 (8) ◽  
pp. 844-850 ◽  
Author(s):  
M. Rubino ◽  
A. Civani ◽  
D. Pagani ◽  
V. Sansone
Keyword(s):  
Clinical Outcome ◽  
Surgical Techniques ◽  
Pinch Strength ◽  
Dash Score ◽  
Carpometacarpal Joint ◽  
Thumb Carpometacarpal Joint ◽  
Thumb Carpometacarpal ◽  
Excision Arthroplasty ◽  
Joint Arthritis

We describe a technique that arose from the observation of the clinical outcome of failed arthrodeses of the thumb carpometacarpal joint. In these cases a pseudoarthrosis developed which, surprisingly, rarely lead to a poor clinical outcome. Thus we developed a simple technique which deliberately caused the formation of a narrow pseudoarthrosis in the carpometacarpal joint. We present a retrospective review of 248 consecutive patients treated for Eaton stages II and III osteoarthritis. We observed a statistically significant improvement in mean appositional and oppositional pinch strength, mean DASH score (63.8 pre-operatively to 10.5 at final follow-up), and the mean pain score (8.3 to 0.2). We conclude that trapeziometacarpal limited excision arthroplasty is a simple and reliable alternative to existing surgical techniques for treating Stage II or III thumb carpometacarpal joint arthritis.

scholarly journals Outcomes after thumb carpometacarpal joint stabilization with an abductor pollicis longus tendon strip for the treatment of chronic instability

2019 ◽  
Vol 140 (2) ◽  
pp. 275-282
Author(s):  
Alexandra Stauffer ◽  
Yvonne Schwarz ◽  
Marion Uranyi ◽  
Florian Schachinger ◽  
Werner Girsch ◽  
...  
Keyword(s):  
Postoperative Outcomes ◽  
Radiographic Examination ◽  
Pinch Strength ◽  
Dash Score ◽  
Level Of Evidence ◽  
Chronic Instability ◽  
Joint Stabilization ◽  
Abductor Pollicis Longus ◽  
Thumb Carpometacarpal

Abstract Introduction Instabilities of the thumb carpometacarpal (CMC) joint, caused by idiopathic ligamentous hyperlaxity, trauma or other conditions may lead to pain, functional impairment and eventually osteoarthritis. Several techniques have been described to enhance stability of the CMC 1. The aim of this study was to evaluate postoperative outcomes after CMC 1 joint stabilization using a soft-tissue procedure in patients with chronic instability. Materials and methods This study was designed as a retrospective study with a single follow-up visit after a minimum of 1 year postoperatively. All patients who underwent stabilization of the CMC 1 with an abductor pollicis longus (APL) tendon strip for chronic, habitual instability were re-assessed using clinical examination, dedicated outcome scores [Visual Analogue Scale (VAS); The Disability of the Arm, Shoulder and Hand (DASH) score; Nelson score; Kapandji opposition score], grip and pinch strength measurements, and radiographic examination. Results 12 patients (15 operated thumbs) with a mean age at surgery of 23.2 (± 9.3) years were included after a mean follow-up period of 3.5 (± 1.3) years. The postoperative outcomes indicated excellent results, with a mean DASH score of 13.3 (± 11.3), VAS 1.1 at rest (and 2.8 during stress) and Nelson score of 87.7 (± 11.3). Postoperative grip, pinch strength and passive stability were not significantly different between operated and non-operated sides (p = 0.852; p = 0.923 and p = 0.428, respectively). We observed one case of recurrent instability besides no other complications. However, patients with trapezium hypoplasia (5 of 12) were more prone to signs of radiographic instability during stress testing. Conclusions Thumb carpometacarpal stabilization with an APL tendon strip yielded excellent clinical outcomes and low morbidity in the mid-term. However, long-term follow-up is needed to assess specifically whether patients with trapezium hypoplasia may be more prone to clinical symptom recurrence than those with normal anatomy. Level of evidence Level IV

Changes in Key Pinch Strength after Excision of the Trapezium and Total Joint Arthroplasty

2004 ◽  
Vol 29 (1) ◽  
pp. 40-41 ◽  
Author(s):  
L. DE SMET ◽  
W. SIOEN ◽  
D. SPAEPEN
Keyword(s):  
Total Joint Arthroplasty ◽  
Ligament Reconstruction ◽  
Joint Arthroplasty ◽  
Pinch Strength ◽  
Pinch Force ◽  
Basal Joint ◽  
Tendon Interposition ◽  
Joint Arthritis

Key pinch force was measured preoperatively and at follow-up (mean 25 months) in patients treated for basal joint arthritis by either trapziectomy with ligament reconstruction and tendon interposition ( n=26) or total joint arthroplasty ( n=27). There was a significant increase in key pinch strength with both treatments, but no difference between the two treatments. Total joint arthroplasty does not appear to produce stronger key pinch than trapziectomy with ligament reconstruction and tendon interposition.

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

Hand ◽  
2021 ◽  
pp. 155894472110031
Author(s):  
Jeanne L. DelSignore ◽  
Kimberly Zambito ◽  
Sarah E. Ballatori
Keyword(s):  
Single Incision ◽  
Pinch Strength ◽  
Short Operative Time ◽  
Pin Fixation ◽  
Long Term Follow Up ◽  
Thumb Carpometacarpal ◽  
And Function ◽  
Suture Suspension

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.

scholarly journals Perilunate Lesions – Clinical and Radiological Results with a Minimum of 2 Years of Follow-up

2021 ◽  
Vol 49 (01) ◽  
pp. 013-018
Author(s):  
Elisabete Ribeiro ◽  
Nuno Oliveira ◽  
Juvenália Ribeiro ◽  
Pedro Varanda ◽  
Luis Filipe Rodrigues
Keyword(s):  
Poor Prognosis ◽  
Contralateral Side ◽  
Pinch Strength ◽  
Dash Score ◽  
Adequate Treatment ◽  
Clinical And Radiological Results ◽  
Carpal Height ◽  
And Cartilage ◽  
Over Time

AbstractPerilunate injuries are complex and rare lesions with circumferential carpal bones, ligamentous and cartilage involvement. Despite optimal surgical treatment, poor prognosis is expected and usually gets worse over time. Our aim was to address clinical and radiological outcomes after 2 years of follow-up. Seven wrists were revised with average age of 35.59 ± 14.01 (range 21–56) years old and mean follow-up of 44.10 ± 14.24 (range 25.60–68.63) months. At the latest follow-up, mean postoperative VAS score for pain was 2.71 ± 3.40 and DASH score was 10.48 ± 10.54. Patients returned to work in 5.00 ± 3.15 months. Strength and Range of Motion (ROM) parameters were ∼80% of the contralateral side, with exception for extension (61%) and radial deviation (73%). After 2 years of follow-up, radiographic arthrosis was observed in 29% of the cases. One of these patients was symptomatic and was proposed for arthrodesis. Mean carpal height was 1.51 ± 0.81 and scapholunate angle was 41.58 ± 22.82°. A correlation was observed between arthritis found at final follow-up and grip (r = −0.8660; p < 0.001) and pinch strength (r = −0.8885; p < 0.001). In conclusion, despite characteristic guarded prognosis, efforts to perform a prompt and adequate treatment are helpful. Clinical and radiological outcomes may not be related. Thus, it is of main importance to understand patients' perception of their sequelae.

scholarly journals Clinical results of the BoneWelding®Fiji® anchor for the treatment of Stener lesions of the thumb

2020 ◽  
Author(s):  
Tobias Kastenberger ◽  
Peter Kaiser ◽  
Gernot Schmidle ◽  
Kerstin Stock ◽  
Stefan Benedikt ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Range Of Motion ◽  
Traumatic Event ◽  
Ulnar Collateral Ligament ◽  
Metacarpophalangeal Joint ◽  
Contralateral Side ◽  
Pinch Strength ◽  
Dash Score ◽  
Collateral Ligament

Abstract Introduction A new technology (Sportwelding®) was recently presented, which uses ultrasonic energy to meld a resorbable suture anchor at the interface with the host bone. A standardized clinical use was not investigated yet. This study prospectively evaluated the surgical and clinical outcomes of the Fiji Anchor® (Sportwelding®, Schlieren, Switzerland) in the repair of an ulnar collateral ligament lesion of the metacarpophalangeal joint of the thumb. Material and methods The range of motion, grip and pinch strength, disability of arm, shoulder and the hand (DASH) and patient rated evaluation (PRWE) score, pain, satisfaction, complications and adverse events were assessed in 24 patients after surgical treatment for an acute displaced rupture or avulsion of the ulnar collateral metacarpophalangeal ligament of the thumb using the Fiji Anchor® after 6, 12 and 52 weeks. Results At final follow up, the range of motion of the metacarpophalangeal joint reached almost the contralateral side (49.3° SD 11.7°). Thumb opposition showed a Kapandji score of 9.7 (SD 0.5; range 9–10). Grip strength, the lateral, tip and the three jaw pinch showed nearly similar values compared to the contralateral side (83–101%). Pain was low (0.2 SD 0.7 at rest and 0.6 SD 1.0 during load). The DASH score was 5.0 (SD 7.3) and the PRWE score was 4.1 (SD 9.0). 81% of patients were very satisfied at final follow-up. Two patients were rated unstable during the follow-up period due to a second traumatic event. Three cases experienced difficulties during anchor insertion, whereby incorrect anchor insertion resulted in damage to the suture material; however, this was resolved after additional training. Conclusion One advantage of this anchor appears to be its stable fixation in cancellous bone. The surgical treatment of an ulnar collateral ligament lesion of the thumb using the Fiji Anchor® can lead to an excellent clinical outcome with a minor complication rate; however, long-term dangers and the cost effectiveness of the procedure are not known yet.

scholarly journals Functional outcome of ligament reconstruction tendon interposition for basal joint arthritis of thumb

2017 ◽  
Vol 3 (3) ◽  
pp. 492
Author(s):  
Saranjeet Singh Jagdev ◽  
Subodh Kumar Pathak ◽  
Nisheet Dave ◽  
Abhijeet Salunke
Keyword(s):  
Ligament Reconstruction ◽  
Advanced Disease ◽  
Pinch Strength ◽  
Dash Score ◽  
Care Hospital ◽  
Strength Gain ◽  
Basal Joint ◽  
Tendon Interposition ◽  
Joint Arthritis ◽  
Cmc Joint

<p><strong>Background:</strong> Thumb carpometacarpal osteoarthritis is a common disease, affecting up to 11% and 53% of men and women in their 50s respectively, which leads to pain, stiffness, weakness of the CMC joint. Patients with advanced disease have multiple surgical options including ligament reconstruction with tendon interposition, resection arthroplasty, silicone implantation, or total joint arthroplasty. The aim of study was to evaluate results of LRTI for CMC joint arthritis.<strong><em> </em></strong></p><p><strong>Methods:</strong> This is a series of 29 patients operated in a tertiary care hospital. All patients included in the study were seen in the outpatient and identified to have basal joint arthritis according to their clinical presentation and classified on the basis of radiologic appearance. Trapeziectomy with ligament reconstruction with tendon interposition was done for patients with advanced disease. All the patients were followed up and assessed for function and disability using DASH score.</p><p><strong>Results:</strong> Average duration of follow up was 36 months with average tip pinch strength gain was 75%, key pinch strength gain 80% , grip strength gain 80 % of other limb. Significant Improvement in active 1<sup>st</sup> web space angle was seen with average of 19.5 degree. Average DASH score was 4.14. Nobody had extreme pain, 3 had mild pain and 2 had moderate pain.<strong> </strong></p><p><strong>Conclusions</strong>: Based on our observation of DASH scores, the results have remained encouraging in most of the cases with restoration of normal anatomy to provide a stable and functional thumb. The success of LRTI in treating trapeziometacarpal arthritis has withstood the test of time.<strong></strong></p>

scholarly journals Simplified abductor pollicis longus suspension interposition arthroplasty for thumb carpometacarpal joint osteoarthritis

2020 ◽  
Author(s):  
Anna Lena Sander ◽  
Clara Friederike Buhrmann ◽  
Katharina Sommer ◽  
Johannes Frank
Keyword(s):  
Grip Strength ◽  
Primary Treatment ◽  
Contralateral Side ◽  
Dash Score ◽  
Interposition Arthroplasty ◽  
Thumb Carpometacarpal Joint ◽  
Abductor Pollicis Longus ◽  
Thumb Carpometacarpal ◽  
Cmc Joint

Abstract Purpose The primary treatment goals for advanced-stage thumb carpometacarpal (CMC) joint osteoarthritis are complete pain relief and restoration of thumb strength. The purpose of the present study was to introduce a variation of the abductor pollicis longus (APL) suspension arthroplasty using a single looping of a radial slip from the APL tendon around the flexor carpi radialis (FCR) tendon combined with RegJoint™ interposition and to determine its efficacy in the treatment of thumb CMC joint osteoarthritis. Methods Between 2015 and 2017, 21 patients were included. The average age was 60.8 years (range 48–79). The mean follow-up was 27.7 months (range 8–50). Evaluation included pain, radial and palmar abduction, tip pinch and grip strength, and Disabilities of the Arm, Shoulder, and Hand (DASH) score. Results Pain averaged 0.3 (range 0–4) at rest and 1.4 (range 0–4) on exertion. The radial and palmar abduction were 97% and 99% compared to the contralateral side. The tip pinch and grip strength were 4.1 kg (range 3–6.5) and 22 kg (range 13.3–40), respectively. The DASH score accounted for 18.5 (range 0.8–41.7). Conclusion The modified APL suspension interposition arthroplasty was an efficient and simplified option for the treatment of thumb CMC joint osteoarthritis, with results comparable or better than other published procedures. The APL suspension technique was easy to perform avoiding difficult bone tunneling and incision of the FCR tendon. The RegJoint™ interposition as spacer prevented impingement of the first metacarpal base on the second metacarpal base or the trapezoid bone.

High revision rates with the metal-on-metal Motec carpometacarpal joint prosthesis

2015 ◽  
Vol 41 (3) ◽  
pp. 322-327 ◽  
Author(s):  
J. K. Thillemann ◽  
T. M. Thillemann ◽  
B. Munk ◽  
K. Krøner
Keyword(s):  
Rating Scale ◽  
Revision Rate ◽  
Numerical Rating Scale ◽  
Elevated Serum ◽  
Consecutive Series ◽  
Dash Score ◽  
Level Of Evidence ◽  
Pain Scores ◽  
Thumb Carpometacarpal

We retrospectively evaluated a consecutive series of 42 Motec thumb carpometacarpal total joint arthroplasties. The primary endpoint was revision with implant removal and trapeziectomy. At follow-up the disability of the arm shoulder and hand (DASH) score, pain on numerical rating scale at rest and with activity and serum chrome and cobalt concentrations were assessed for both unrevised and revised patients. At a mean follow-up of 26 months, 17 patients had been revised. The 2 year cumulative revision rate was 42% (95% CI, 28–60%). The DASH score and pain scores at rest and with activity were comparable between the patients whose thumbs remained unrevised and those revised. Patients with elevated serum chrome and cobalt levels had significantly higher DASH and pain scores, but elevated levels were not associated with revision. The revision rate in this study is unacceptably high. However, pain and DASH scores after revision are acceptable and comparable with patients with non-revised implants. Level of evidence: IV

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