Suture suspension arthroplasty for thumb carpometacarpal osteoarthritis under wide-awake anesthesia

There is little difference in the outcome of various surgical treatment for thumb carpometacarpal osteoarthritis. Suture suspension arthroplasty is a very simple technique without sacrifice of tendon or specific implants and can be performed under regional anesthesia. We hypothesize that the technique yields similar good results to an approach under general anesthesia at less medical cost.

Eighteen patients underwent suture suspension arthroplasty by trapezial excision and metacarpal suspension using #2 high-strength suture passed from the attachment of abductor pollicis longus to the most distal part of flexor carpi radialis without tendon transfer or K-wire fixation. Nine patients received wide-awake anesthesia and 9 patients received general anesthesia. Postoperatively, patients were evaluated by clinical and radiographic outcomes. We investigated the first to second metacarpal angle, the first metacarpophalangeal angle, trapezial space ratio, grip strength, pinch strength, Kapandji score, DASH score, medical cost and patient satisfaction.

Five of 18 patients were male. Average age was 66.3 (range 53-76). Eleven patients had Eaton stage 3 and 7 had stage 4. The mean follow-up was 17.9 months (range, 7-48 months). Postoperatively, the first to second metacarpal angle, the first metacarpophalangeal angle, grip strength, DASH and Kapandji score showed significant improvements. However, there is no significant difference of clinical and radiographic outcome between wide-awake anesthesia and general anesthesia. Medical cost was significantly less in wide-awake anesthesia than in general anesthesia. Most patients receiving wide-awake anesthesia would hope the same anesthesia if they were to have surgery again.

Suture suspension arthroplasty for thumb carpometacarpal osteoarthritis is a very simple technique and has good results. Because of the simplicity, wide-awake surgery is possible and yields similar good results to an approach under general anesthesia at less medical cost. Therefore, Suture suspension arthroplasty for thumb carpometacarpal osteoarthritis under wide-awake anesthesia is highly recommended.