Suture Button Suspensionplasty in the Treatment of Carpometacarpal Arthritis: A Retrospective Analysis of One Surgeon's Experience Over 9 Years

Nathan Walter; Emily Duncan; Mellisa Roskosky; Tyler B Smith; Michael S Shuler

doi:10.1016/j.jhsg.2019.11.002

Suture Button Suspensionplasty in the Treatment of Carpometacarpal Arthritis: A Retrospective Analysis of One Surgeon's Experience Over 9 Years

J Hand Surg Glob Online. 2020 Jan 8;2(1):25-30. doi: 10.1016/j.jhsg.2019.11.002. eCollection 2020 Jan.

Authors

Nathan Walter¹, Emily Duncan¹, Mellisa Roskosky², Tyler B Smith³, Michael S Shuler³

Affiliations

¹ Augusta University/Medical College of Georgia Partnership, Athens, GA.
² Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.
³ Athens Orthopedic Clinic, Athens, GA.

Abstract

Purpose: Trapeziectomy with suture button suspensionplasty (SBS) to treat thumb carpometacarpal (CMC) arthritis has been proposed as an alternative to ligament reconstruction tendon interposition. There have been limited large-scale or long-term reports regarding SBS outcomes. Single-surgeon intermediate follow-up is reported.

Methods: We conducted a retrospective review of patients undergoing SBS procedures by a single surgeon. Implant manufacturer and postoperative immobilization protocol were recorded. Surgical outcomes, complications, and revision procedures were identified. Postoperative Disabilities of the Arm, Shoulder, and Hand scores were collected.

Results: A total of 242 SBS surgeries were included, involving 215 patients, average age 64.82 years (range, 42-86 years). Average follow-up was 35 ± 25 months. In all, 183 Arthrex and 59 Stryker systems were used, 42 of which were immobilized for 6 weeks after surgery and 200 of which were mobilized at 2 weeks afterward. Postoperative Disabilities of the Arm, Shoulder, and Hand surveys were completed by 122 patients (57%), with an average score of 12. No scaphometacarpal abutment was reported. Thirteen complications were reported (5%), 7 of which were implant-associated (3%) and 6 of which were not (2%). Implant-associated complications consisted of 3 suture button pull-outs, 2 thumb-index metacarpal abutments, one suture tail irritation, and one index metacarpal fracture. Operative revision was required in 4 of 7 implant-associated cases and 5 of 6 non-implant associated cases. No suture button pull-outs required revision surgery.

Conclusions: Results for a large series of SBS for CMC arthroplasty with intermediate follow-up revealed excellent clinical outcomes and low complication rates.

Clinical relevance: Suture button suspensionplasty as an alternative to ligament reconstruction tendon interposition may be a viable option for treating thumb CMC arthritis. In addition, a technique to manage thumb-index metacarpal abutment is described.

Keywords: Basilar thumb arthritis; Carpometacarpal arthritis; Carpometacarpal arthroplasty; Suture button suspensionplasty; Trapeziectomy.