Journal List > J Korean Soc Surg Hand > v.22(2) > 1106583

Park, Shin, and Cha: Evaluation of Anti-Subsidence Effect of Abductor Pollicis Longus Suspensionplasty in Carpometacarpal Arthritis of the Thumb

Abstract

Purpose

To evaluate the anti-subsidence effect of suspensionplasty using abductor pollicis longus (APL) tendon in carpometacarpal (CMC) arthritis of the thumb.

Methods

From June 2009 to May 2016, hematoma distraction arthroplasty (HDA; group A, 10 cases) and HDA with suspensionplasty using APL tendon (group B, 7 cases) were performed in total 17 patients with CMC arthritis. The K-wire was fixed from 1st metacarpal to 2nd metacarpal in both group to maintain the empty space for 6 weeks until the fibrous tissue fill the space. We measured the preoperative trapezium space height with picture archiving and communication (PACS) system and compare the height with that was measured postoperatively. Additionally the subsidence rate checked sequentially with follow-up plain radiography.

Results

The subsidence ratios (subsidence/trapezium height) were average 33.2% in group A and 31.4% in group B. There is no statistical difference between two groups. Six weeks after pin removal almost of subsidence occurred, and then from 3 months after surgery to 6 months after surgery, few subsidence was occurred and it is average only 8% of total subsidence. The trial of distraction the empty space when perform the Kirschner wire (K-wire) fixation, it does not influence the prevention of subsidence. Between distraction height and subsidence, there was no statistical relevance.

Conclusion

Although suspensionplasty was known as one of methods to prevent the subsidence, it is thought to be not very helpful method to prevent subsidence of thumb in CMC arthritis.

Figures and Tables

Fig. 1

Surgical method. (A) Trapezium excision, (B) half tendon of abductor pollicis longus (APL) harvested, (C) APL pass the empty space through the stab incision of flexor carpi radialis tendon, and (D) postoperative plain radiography.

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Fig. 2

Measurement method of trapezial height. Measure the trapezial height from scaphoid distal pole to 1st metacarpal base in posteroanterior view perpendicular manner to scaphoid distal pole.

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Fig. 3

A 47-year-old female with carpometacarpal (CMC) arthritis of thumb. Hematoma distraction arthroplasty was performed. Six weeks after pin removal, almost of subsidence occurred. From then, subsidence progress slowly. (A) Preoperative, (B) postoperative, (C) 3 months follow-up, and (D) 6 months follow-up radiography. The measurement of space height was 9.33 mm. (E) There was also CMC arthritis in the thumb of contralateral hand. The space height was 10.81 mm.

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Fig. 4

The chart of serial measurement of trapezial space height. Through 6 weeks after pin removal, subsidence progress rapidly. Few subsidence has occurred since then. Preop, preoperative; Postop, postoperative.

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Table 1

Demographic patient data

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Table 2

The average value of radiologic measurement in total 17 cases

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Values are presented as average (range). There is no statistical difference between two groups in radiologic parameters by analysis with Mann-Whitney U-test.

*Preoperative.

Table 3

Influence of traction maneuver to prevent subsidence

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The analysis was done with Spearman and Kendall's tau-b test. The distraction height (postoperative fixation height–preoperative trapezial height) does not influence the subsidence ratio or subsidence.

Notes

CONFLICT OF INTEREST No potential conflict of interest relevant to this article was reported.

References

1. Haara MM, Heliovaara M, Kroger H, et al. Osteoarthritis in the carpometacarpal joint of the thumb: prevalence and associations with disability and mortality. J Bone Joint Surg Am. 2004; 86:1452–1457.
2. Armstrong AL, Hunter JB, Davis TR. The prevalence of degenerative arthritis of the base of the thumb in postmenopausal women. J Hand Surg Br. 1994; 19:340–341.
crossref
3. Berger RA. A technique for arthroscopic evaluation of the first carpometacarpal joint. J Hand Surg Am. 1997; 22:1077–1080.
crossref
4. Bettinger PC, Linscheid RL, Berger RA, Cooney WP 3rd, An KN. An anatomic study of the stabilizing ligaments of the trapezium and trapeziometacarpal joint. J Hand Surg Am. 1999; 24:786–798.
crossref
5. Goldfarb CA, Stern PJ. Indications and techniques for thumb carpometacarpal arthrodesis. Tech Hand Up Extrem Surg. 2002; 6:178–184.
crossref
6. Vermeulen GM, Slijper H, Feitz R, Hovius SE, Moojen TM, Selles RW. Surgical management of primary thumb carpometacarpal osteoarthritis: a systematic review. J Hand Surg Am. 2011; 36:157–169.
crossref
7. Yao J, Song Y. Suture-button suspensionplasty for thumb carpometacarpal arthritis: a minimum 2-year follow-up. J Hand Surg Am. 2013; 38:1161–1165.
crossref
8. Chang EY, Chung KC. Outcomes of trapeziectomy with a modified abductor pollicis longus suspension arthroplasty for the treatment of thumb carpometacarpal joint osteoarthritis. Plast Reconstr Surg. 2008; 122:505–515.
crossref
9. Sirotakova M, Figus A, Elliot D. A new abductor pollicis longus suspension arthroplasty. J Hand Surg Am. 2007; 32:12–22.
crossref
10. Low TH, Hales PF. High incidence and treatment of flexor carpi radialis tendinitis after trapeziectomy and abductor pollicis longus suspensionplasty for basal joint arthritis. J Hand Surg Eur Vol. 2014; 39:838–844.
crossref
11. Kaarela O, Raatikainen T. Abductor pollicis longus tendon interposition arthroplasty for carpometacarpal osteoarthritis of the thumb. J Hand Surg Am. 1999; 24:469–475.
crossref
12. Tomaino MM. Suspensionplasty for basal joint arthritis: why and how. Hand Clin. 2006; 22:171–175.
crossref
13. Field J, Buchanan D. To suspend or not to suspend: a randomised single blind trial of simple trapeziectomy versus trapeziectomy and flexor carpi radialis suspension. J Hand Surg Eur Vol. 2007; 32:462–466.
crossref
14. Goffin D, Saffar P. A radiological technique for measurement of the height of the trapezial cavity: applications in pre- and post-operative assessment in osteoarthritis of the base of the thumb. Ann Chir Main Memb Super. 1990; 9:364–368.
15. Sandvall BK, Cameron TE, Netscher DT, Epstein MJ, Staines KG, Petersen NJ. Basal joint osteoarthritis of the thumb: ligament reconstruction and tendon interposition versus hematoma distraction arthroplasty. J Hand Surg Am. 2010; 35:1968–1975.
crossref
16. Kadiyala RK, Gelberman RH, Kwon B. Radiographic assessment of the trapezial space before and after ligament reconstruction and tendon interposition arthroplasty. J Hand Surg Br. 1996; 21:177–181.
17. Tomaino MM, Pellegrini VD Jr, Burton RI. Arthroplasty of the basal joint of the thumb: long-term follow-up after ligament reconstruction with tendon interposition. J Bone Joint Surg Am. 1995; 77:346–355.
crossref
18. Gray KV, Meals RA. Hematoma and distraction arthroplasty for thumb basal joint osteoarthritis: minimum 6.5-year follow-up evaluation. J Hand Surg Am. 2007; 32:23–29.
crossref
19. Lins RE, Gelberman RH, McKeown L, Katz JN, Kadiyala RK. Basal joint arthritis: trapeziectomy with ligament reconstruction and tendon interposition arthroplasty. J Hand Surg Am. 1996; 21:202–209.
crossref
20. Kuhns CA, Emerson ET, Meals RA. Hematoma and distraction arthroplasty for thumb basal joint osteoarthritis: a prospective, single-surgeon study including outcomes measures. J Hand Surg Am. 2003; 28:381–389.
crossref
21. Dell PC, Muniz RB. Interposition arthroplasty of the trapeziometacarpal joint for osteoarthritis. Clin Orthop Relat Res. 1987; (220):27–34.
crossref
22. Downing ND, Davis TR. Trapezial space height after trapeziectomy: mechanism of formation and benefits. J Hand Surg Am. 2001; 26:862–868.
crossref
23. Yang SS, Weiland AJ. First metacarpal subsidence during pinch after ligament reconstruction and tendon interposition basal joint arthroplasty of the thumb. J Hand Surg Am. 1998; 23:879–883.
crossref
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