Over 5-Year Follow-up of Arthroscopic Partial Trapeziectomy and Suture Button Suspension Arthroplasty for Thumb Carpometacarpal Arthritis

We have performed arthroscopic partial trapeziectomy with suspension arthroplasty (APTSA) using a suture button for Eaton stage III thumb carpometacarpal (CM) arthritis. In this study, we examined over 5-year effectiveness of this procedure in terms of postoperative clinical results and morphological changes of radiographic view. Twenty-eight wrists of 25 patients underwent APTSA for stage III painful thumb CM arthritis. Three wrists of 3 males and 22 wrists of 25 females were examined. The age at surgery ranged from 48 to 84 years. The distal surface of the trapezium was removed arthroscopically, and the thumb metacarpal was suspended by a suture button passed through the first and second metacarpal. Pain was evaluated by visual analogue scale 10, range of motion was scaled by the Kapandji score. Grip and key pinch strength were evaluated with the improvement rate calculated by pre- and postoperative values in all cases, and they were compared with the contralateral side in 16 unilateral cases. The first metacarpal radial and dorsal translation were calculated using our original radial and dorsal translation index on posteroanterior and lateral radiographs. The ratio of distance between the proximal end of the first metacarpal and distal end of the scaphoid divided by the first metacarpal length was evaluated as a suspension effect, and morphological changes on the removed surface of the trapezium were observed radiographically. Q-DASH score was used for overall evaluation. The mean follow-up period was 78 months. The mean preoperative pain score of 7.81 decreased to 0.29 postoperatively. The Kapandji score improved from 8.8 to 9.9, the average grip strength from 16.8 to 22.3 kg, and the average key pinch strength from 4.5kg to 6.5kg, improvement rates of each were 0.34 and 0.63. The correction of radial translation was maintained over 5 years; however dorsal translation was not. The radiographs showed changes in osteophytic remodeling of the removed surface of the trapezium and regeneration of the joint space with good congruity, and the first metacarpal was maintained in the reduced position on posteroanterior view. The suspension effect was unchanged, the q-DASH score improved from 47.1 to 7.1. The effectiveness of APTSA can be expected with the reconstruction of new joints with marked clinical recovery.