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

In 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.