scholarly journals Suspension arthroplasty in the treatment of thumb carpometacarpal osteoarthritis

2021 ◽  
Vol 12 (4) ◽  
Author(s):  
Gianfilippo Caggiari ◽  
Fabrizio Polese ◽  
Cristiano Rosetti ◽  
Emanuele Ciurlia ◽  
Matteo Brusoni ◽  
...  
Keyword(s):  
Surgical Techniques ◽  
Operation Time ◽  
Flexor Carpi Radialis ◽  
Abductor Pollicis Longus ◽  
Total Operation Time ◽  
Age At Surgery ◽  
Thumb Carpometacarpal ◽  
Carpometacarpal Osteoarthritis ◽  
Suture Suspension

Literature presents several examples of surgical techniques for the treatment of carpometacarpal osteoarthritis. In our study we used a modified Ceruso’s suspended arthroplasty technique. In this study, 53 patients from 2011 to 2017 underwent arthroplasty with trapezius excision and suture suspension between abductor pollicis longus and flexor carpi radialis. The average age at surgery was 69, the participants were 43 women and 10 men. The average total operation time was 59 minutes. The modified CMC suspension arthroplasty technique provides excellent results compared with those in the literature.

Ligament Reconstruction of the Thumb Carpometacarpal Joint using a Modified Eaton and Littler Technique

1985 ◽  
Vol 10 (1) ◽  
pp. 115-116 ◽  
Author(s):  
A. MAGNUSSON ◽  
K. BERTHEUSSEN ◽  
A. WEILBY
Keyword(s):  
Ligament Reconstruction ◽  
Carpometacarpal Joint ◽  
Thumb Carpometacarpal Joint ◽  
Flexor Carpi Radialis ◽  
Dynamic Fixation ◽  
Abductor Pollicis Longus ◽  
Thumb Carpometacarpal

A modification of the Eaton and Littler technique for reconstructing ligaments and restoring stability of the carpometacarpal joint of the thumb is described. We use a strip from the flexor carpi radialis tendon, which is split down to the crest of the trapezium. The tendon strip is led beneath the ligaments and the abductor pollicis longus insertion, through a tunnel drilled in the metacarpal base, around the insertion of the flexor carpi radialis tendon and finally back to the dorsum of the base of the metacarpal where it is inserted in the periosteum. This procedure ensures a dynamic fixation of the apical ligament and therefore a better stability.

Thenar insertion of abductor pollicis longus accessory tendons and thumb carpometacarpal osteoarthritis

2000 ◽  
Vol 25 (3) ◽  
pp. 458-463 ◽  
Author(s):  
Michael S. Roh ◽  
Robert J. Strauch ◽  
Liangfeng Xu ◽  
Melvin P. Rosenwasser ◽  
Robert J. Pawluk ◽  
...  
Keyword(s):  
Abductor Pollicis Longus ◽  
Thumb Carpometacarpal ◽  
Carpometacarpal Osteoarthritis

High incidence and treatment of flexor carpi radialis tendinitis after trapeziectomy and abductor pollicis longus suspensionplasty for basal joint arthritis

2013 ◽  
Vol 39 (8) ◽  
pp. 838-844 ◽  
Author(s):  
T. H. Low ◽  
P. F. Hales
Keyword(s):  
Pain Relief ◽  
Steroid Injection ◽  
Revision Operation ◽  
Thumb Carpometacarpal Joint ◽  
Flexor Carpi Radialis ◽  
Abductor Pollicis Longus ◽  
High Incidence ◽  
Good Pain Relief ◽  
Thumb Carpometacarpal ◽  
Joint Arthritis

We reviewed the incidence and treatment of flexor carpi radialis tendinitis in 77 patients (81 thumbs) who had trapeziectomy and abductor pollicis longus suspensionplasty for thumb carpometacarpal joint arthritis. Eighteen patients, 20 wrists (25%) had flexor carpi radialis tendinitis. The onset was 2–10 months (mean 4.7) after surgery. Two cases had preceding trauma. Eight cases (40%) responded to splinting and steroid injection. Ten patients, 12 wrists (60%) underwent surgery after failing non-operative treatment. Eleven wrists had frayed or partially torn flexor carpi radialis tendon and one had a complete tendon rupture with pseudotendon formation. Flexor carpi radialis tenotomy and pseudotendon excision were performed. All operated patients obtained good pain relief initially post-operatively. However, the pain recurred in two patients after 8 months. One required a local steroid injection for localized tenderness at the site of the proximal tendon stump. The other patient required a revision operation for scaphotrapezoid impingement. Both obtained complete pain relief. Our study has shown a high incidence of flexor carpi radialis tendinitis following trapeziectomy and abductor pollicis longus suspensionplasty. Patients should be warned about this potential complication.

Lessons Learned: Trapeziectomy and Suture Suspension Arthroplasty for Thumb Carpometacarpal Osteoarthritis

2020 ◽  
Author(s):  
Ashley L. Pistorio ◽  
John B. Moore
Keyword(s):  
Surgical Technique ◽  
Grip Strength ◽  
Preoperative Assessment ◽  
Lessons Learned ◽  
Pain Scores ◽  
Proximal Migration ◽  
Surgeon Experience ◽  
Thumb Carpometacarpal ◽  
Carpometacarpal Osteoarthritis ◽  
Suture Suspension

AbstractIn this study, we describe refinements of an accepted technique made by a single surgeon for trapeziectomy and suture suspension arthroplasty for thumb carpometacarpal (CMC) osteoarthritis after 220 cases over 4 years. Results are derived from 77 patients who underwent treatment using this technique comparing postoperative results with preoperative assessment and had sufficient data for inclusion. The surgical technique is described, including tips and modifications to avoid known possible complications. All patients in this study had advanced Eaton stage III or IV osteoarthritis. Grip strength and key pinch showed statistically significant improvement, and the improvement in palmar pinch approached significance. Pain scores were significantly decreased with over 50% of the patients rating their pain at 0 postoperatively. The overall complication rate was very low, and improvements in technique were made to mitigate future occurrence. This surgical technique for the treatment of thumb CMC arthritis achieved pain relief and recreated ligamentous support of the base of the first metacarpal to resist proximal migration after trapeziectomy, providing an increase in grip strength and key pinch with return of range of motion early in the postoperative period. Refinements on this technique through a large volume single surgeon experience provide technical tips for optimizing outcomes.

scholarly journals Surgeon Preference, Influence, and Treatment of Thumb Carpometacarpal Arthritis

Hand ◽  
2017 ◽  
Vol 13 (4) ◽  
pp. 403-411 ◽  
Author(s):  
Zachary Deutch ◽  
Steven R. Niedermeier ◽  
Hisham M. Awan
Keyword(s):  
Online Survey ◽  
The United States ◽  
Current Evidence ◽  
Opioid Medications ◽  
American Society ◽  
Thumb Carpometacarpal ◽  
Tendon Interposition ◽  
Carpometacarpal Osteoarthritis ◽  
And Training ◽  
Suture Suspension

Background: The purpose of this study was to evaluate current surgical practice patterns, the factors that influence these patterns, and overall trends in the treatment of thumb carpometacarpal osteoarthritis. Methods: An online survey containing 14 questions was sent to all active members of the American Society for Surgery of the Hand. Information on demographics and treatments was collected. Results were anonymously uploaded to an online spreadsheet. Results: A total of 823 responses were recorded. Trapeziectomy with ligament reconstruction and tendon interposition (LRTI) using whole flexor carpi radialis was the most popular technique at 37.44%. In all, 26.38% of surgeons with fewer than 5 years of experience utilize trapeziectomy with suture suspension (bone anchor based or tendon based); 55.76% choose a particular procedure because of “Personal Clinical Experience” over “Current Evidence” and “Training.” In addition, 24.17% of surgeons who have been practicing for longer than 5 years have changed procedures in the last 5 years. In the United States, 97.2% of hand surgeons prescribe either oxycodone or hydrocodone postoperatively compared with just 23.75% of international hand surgeons. Conclusions: The results show that trapeziectomy with LRTI remains the most popular treatment of choice. The use of trapeziectomy with suture suspension is on the rise, particularly in younger surgeons. International hand surgeons rely more on current evidence, utilize less postoperative therapy and opioid medications, and change procedures more often than US hand surgeons.

scholarly journals Autologous Fat Transplantation for Thumb Carpometacarpal Joint Osteoarthritis (Liparthroplasty): A Case Series with Two Years of Follow-UP

2020 ◽  
Vol 10 (1) ◽  
pp. 113
Author(s):  
Stefan M. Froschauer ◽  
Matthias Holzbauer ◽  
Raphael Wenny ◽  
Manfred Schmidt ◽  
Georg M. Huemer ◽  
...  
Keyword(s):  
Remission Rate ◽  
Surgical Techniques ◽  
Case Series ◽  
Thumb Carpometacarpal Joint ◽  
A Value ◽  
Autologous Fat Transplantation ◽  
Thumb Carpometacarpal ◽  
Satisfaction Rates ◽  
Carpometacarpal Osteoarthritis

Adipose-derived mesenchymal stem cell (ASC) therapy is currently a focus of regenerative medicine. Lipoaspirate is rich in ASCs and is evolving into a promising, less-invasive tool to treat thumb carpometacarpal osteoarthritis as compared with common surgical techniques, for example, trapeziectomy or prosthesis implantation. The present study aimed to examine the effect of 1 mL intraarticular lipoaspirate injection (liparthroplasty) in 31 thumb carpometacarpal osteoarthritis patients (27 woman and four men) with a median age of 58 (interquartile range (IQR) of 10) years and Eaton–Littler Stage 2 or 3. Median pain levels assessed via visual analogue scale significantly decreased from 7 (IQR 2) to 4 (IQR 6) after six months (p < 0.0001) and 2 (IQR 5) after two years (p < 0.0001). Median pre-interventional Disabilities of the Arm, Shoulder and Hand (DASH) scores of 59 (IQR 26) significantly reduced to a value of 40 (IQR 43) after six months (p = 0.004) and to 35 (IQR 34) after two years (p < 0.0001). Subjective grip strength showed no significant improvement. However, the time until recurrence of symptoms was measured and a cumulative remission rate of 58% was detected after two years. Satisfaction rates were 68% after six months and 51% after two years. In conclusion, liparthroplasty represents a promising option to reduce pain and functional impairment and to postpone surgery for a certain period of time.

scholarly journals FRI0635-HPR PATIENTS’ MOTIVATION AND GOALS FOR THUMB CARPOMETACARPAL OSTEOARTHRITIS SURGERY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 921.2-922
Author(s):  
E. M. H. Gravås ◽  
I. Kjeken ◽  
R. Nossum ◽  
R. E. Mehl Eide ◽  
Å. Klokkeide ◽  
...  
Keyword(s):  
Pharmacological Treatment ◽  
Cross Sectional Study ◽  
Activity Limitations ◽  
Hand Osteoarthritis ◽  
Sectional Study ◽  
Cross Sectional ◽  
Eular Recommendations ◽  
High Motivation ◽  
Thumb Carpometacarpal ◽  
Carpometacarpal Osteoarthritis

Background:Osteoarthritis (OA) in the thumb carpometacarpal joint (CMCJ) is a prevalent disease which may lead to structural damage, severe pain and functional limitations, but for which there is yet no cure. Evidence-based treatment recommendations state that all patients with hand OA should be offered patient education, hand exercises, and provision of assistive devices and orthoses. Pharmacological therapy is recommended as a symptom relieving supplement. The main indication for CMCJ surgery is pain and poor function, and such surgery should be considered only when other treatment has proven insufficient in relieving pain (1). Previous research has shown that high motivation is a significant predictor for deciding to undergo CMCJ surgery (2), but there is little knowledge regarding which factors that motivates patients for undergoing such surgery.Objectives:The objective of this study was to explore patient goals and motivation for surgery, and factors characterizing patients highly motivated for surgery.Methods:This cross-sectional study included 180 patients referred from their general practitioner for CMCJ surgical consultation. Goals for surgery were collected with an open-ended question and analysed by linking the content of each goal to domains in the International Classification of Functioning, Disability and Health coding system. Motivation for surgery was rated with a Numeric Rating Scale (NRS, 0-10, 0=no motivation). Activity limitations was self-reported using the Measure of Activity Performance of the Hand (MAP-Hand, score 1 to 4, 1=no activity problems) and the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH; score 0-100, 0=no disability). Factors that characterized patients highly motivated for surgery (NRS≥8) were explored with multivariate regression analyses.Results:Mean age of participants was 63 years (SD 7.6) and 142 (79%) were women. The most common goals for surgery were to reduce pain and improve arm and hand use. Fifty-six (31%) of the patients were characterized as highly motivated for surgery. High motivation for surgery was strongly associated with more activity limitations (MAP-Hand; (OR 4.00, p=0.008)), living alone (OR 3.18, p=0.007) and a young age (OR 0.94, p=0.002).Conclusion:Decisions on CMCJ OA surgery should be based on assessment and discussion of patients’ life situation, hand pain, activity limitations and motivation and goals for surgery. According to the EULAR recommendations, previously received conservative and pharmacological treatment should also be evaluated.References:[1] Kloppenburg, M., et al. (2018). “2018 update of the EULAR recommendations for the management of hand osteoarthritis.” Ann Rheum Dis. 0; 1-9[2] Gravas, E. M. H., et al. (2019). “Non-pharmacological treatment gap preceding surgical consultation in thumb carpometacarpal osteoarthritis - a cross-sectional study.” BMC Musculoskelet Disord 20(1): 180.Disclosure of Interests:None declared

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