Suture Anchor Suspension and Fascia Lata Interposition Arthroplasty for Basal Joint Arthritis of the Thumb

BACKGROUND: Although the ideal treatment of thumb basal joint osteoarthritis is debated, most surgeons advocate trapeziectomy with ligament reconstruction tendon interposition arthroplasty. However, harvesting and weaving autologous tendon creates scarring, alters wrist kinetics, may prolong recovery, and is time consuming. In this article, the authors propose a new method of arthroplasty using suture anchor suspensionplasty and cadaveric fascia lata interposition. METHODS: Thirty-eight consecutive patients who underwent 46 thumb carpometacarpal joint arthroplasties were analyzed retrospectively. All patients were treated by the senior author (J.U.) at one institution over 6 years. Total (n = 17) or partial (n = 29) trapeziectomy was performed followed by Mitek suture anchor suspension of the first to the second metacarpal and cadaveric fascia lata interposition. Preoperative and postoperative evaluations of pain, satisfaction, and strength were undertaken in the short term (3 months) and long term (last follow-up). Follow-up averaged 4 years. RESULTS: Thirty-one women and seven men were treated, all with advanced osteoarthritis (Eaton stage III and IV). 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, p < 0.001) and 2.0 kg (81 percent improvement, p < 0.001), respectively. Three patients had minor complications. CONCLUSIONS: Thumb basal joint arthroplasty using suture anchor suspension and fascia lata interposition is a reliable, effective, and expeditious technique. It obviates the need for tendon harvest and manipulation while treating the underlying pathomechanics of the disorder.