Page 37 - HOI Outcomes 2019
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 New Surgical Approaches to Thumb Basal Joint Osteoarthritis
by Paul T. Dinh, MD, and
Shaunak S. Desai, MD
Thumb carpometacarpal joint osteoarthritis is a common site of non-traumatic arthritis in the hand. The condition affects six times as many women as men and generally occurs in their 50s and 60s. This saddle-shaped joint allows for a wide range of motion which makes this joint intrinsically unstable, leading to abnormal contact stress and cartilage wear. Patients with this disorder will complain of pain localized to the base of the thumb. The pain is activity related, often after excessive forceful pinching. The mainstay of initial treatment of basal thumb arthritis of any stage is activity modifications, rest, nonsteroidal anti-inflammatory drugs, exercises and splinting.
To control symptoms and improve function, a variety of surgical procedures are available when conservative measures have failed. These include denervation, arthroscopy, joint replacement
and fusion. Most common are excisional procedures in which the trapezium is removed with or without ligament reconstruction and/
or tendon interposition. The main concern with excisional procedures is the potential subsidence and instability of the thumb, leading to bone impingement and weakness in pinch strength.
To reduce this risk of proximal migration, many
surgeons will perform a ligament reconstruction or place a tendon in the newly created trapezial void.
A novel technique is to use a suture-button suspensionplasty to maintain the height of the thumb. Similar to the hematoma distraction arthroplasty, which solely involves removal of the trapezium with temporary pin fixation, this technique involves cortical button placement on the thumb and index finger metacarpals connected by a high tensile, multi-strand polyethylene suture. The purpose of this all-internal device is to provide an alternative to temporary external pin fixation, (which can lead to potential complications and prevent possible early rehabilitation). Published results of the suture-button technique have shown that this is a safe and effective method in treating thumb basal joint arthritis.
A brief overview of the technique demonstrates
that surgeons can have significant latitude with
the method utilized. Incorporating procedures already used in current practice, the technique allows for additional adjunct procedures including ligament reconstruction and/or tendon interposition. In addition, thumb metacarpal-phalangeal joint hyperextension still needs to be addressed with this technique. While the procedure does involve the need for a secondary incision and implant, suture- button suspensionplasty provides the advantage
of secure fixation and the potential for early mobilization.

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